Active NPI
Heather Lynn Rose-Carlson, PSY.D., L.P.
- Clinical Psychologist
- Duluth, MN
National Provider Identifier
1295903482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP4906
- Practice address
- 1707 Miller Trunk Hwy
Duluth, MN 55811-1880 - Phone
- (218) 729-6480
- Fax
- (218) 729-9238
- NPI assigned
- Feb 11, 2008
- Last updated
- Mar 17, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP4906 | MN | Primary |
Addresses
Primary practice location
1707 Miller Trunk Hwy
Duluth, MN 55811-1880
Mailing address
1707 Miller Trunk Hwy
Duluth, MN 55811-1880
Phone (218) 729-6480
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2006
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
4560 Norway Pines PL
Hermantown, MN 55811-1253
Phone (218) 348-1565
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647475200000",
"number": "1295903482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1707 MILLER TRUNK HWY",
"city": "DULUTH",
"state": "MN",
"postal_code": "558111880",
"telephone_number": "218-729-6480",
"fax_number": "218-729-9238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1707 MILLER TRUNK HWY",
"city": "DULUTH",
"state": "MN",
"postal_code": "558111880",
"telephone_number": "218-729-6480",
"fax_number": "218-729-9238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE-CARLSON",
"first_name": "HEATHER",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PSY.D., L.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-11",
"last_updated": "2022-03-17",
"certification_date": "2022-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP4906",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.