Provider Demographics
NPI:1689039901
Name:HERN, REBECCA (PSYD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:HERN
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CHURCHILL ST W STE 102
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6297
Mailing Address - Country:US
Mailing Address - Phone:651-564-9912
Mailing Address - Fax:
Practice Address - Street 1:209 CHURCHILL ST W STE 102
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6297
Practice Address - Country:US
Practice Address - Phone:651-564-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5960103T00000X
MN59601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist