| Doctor Name: | MS. JOANNA KELLY-HEIGIS |
| NPI Number: | 1740654888 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., LMFT |
| License Number: | 3192 |
| Business Practice Address: | 16201 90th Street Nw, Suite 200 Otsego, MN - 55330 |
| Business Phone Number: | 7637469492 |
| Business Fax Number: | 7637463685 |
| Mailing Address: | 1900 Silver Lake Road Nw, Suite 110 NEW BRIGHTON |
| State: | MN |
| Postal Code: | 55112 |
| Phone Number: | 6513791718 |
| Fax Number: | 6513791738 |
| NPI Enumeration Date: | 11/29/2015 |
| NPI Last Update Date: | 12/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 3192 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |