Provider Demographics
NPI:1760371611
Name:HEATHER SVOBODA, MA, LP LLC
Entity type:Organization
Organization Name:HEATHER SVOBODA, MA, LP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SVOBODA
Authorized Official - Suffix:
Authorized Official - Credentials:MA LP
Authorized Official - Phone:651-300-6266
Mailing Address - Street 1:1678 SELBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6149
Mailing Address - Country:US
Mailing Address - Phone:651-300-6266
Mailing Address - Fax:
Practice Address - Street 1:1678 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6149
Practice Address - Country:US
Practice Address - Phone:651-300-6266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNLP5110OtherBOARD OF PSYCHOLOGY
1629214747OtherNPPES (NPI)