SAMANTHA LYNN KLOCKOW (PSYD, LP) – Clinical Psychologist, NPI 1457860884
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,110 CLINICAL PSYCHOLOGIST in MN
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Provider Addresses for SAMANTHA LYNN KLOCKOW (PSYD, LP)
1900, Silver Lake Road Northwest, New Brighton, Ramsey County, Minnesota, 55112, United States
NEW BRIGHTON, MN 55112
Phone:
Type: Mailing
11660, Round Lake Boulevard Northwest, Mercy, Coon Rapids, Anoka County, Minnesota, 55433, United States
COON RAPIDS, MN 554332638
Phone: (763) 767-3350
Type: Location
1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON, MN 551121789
Phone: (651) 628-9566
Fax: (651) 628-0411
Type: Mailing
4131 W LOOMIS RD APT 120
GREENFIELD, WI 532212006
Phone: (414) 424-2445
Fax: (414) 424-2446
Type: Location
W175N11120 STONEWOOD DR
GERMANTOWN, WI 530224799
Phone: (800) 438-1772
Fax: (262) 345-5562
Type: Mailing
8670 210TH ST W
LAKEVILLE, MN 550447000
Phone: (800) 438-1772
Fax: (262) 345-5562
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-07-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20200422002676 | I | Clinical Psychologist | MN | TBD |
| I20210723002079 | I | Clinical Psychologist | WI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55112)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | MN | |
| Mental Health Counselor | MN | |
| Clinical Social Worker | MN | |
| Mental Health Counselor | MN | |
| Mental Health Counselor | MN | |
| Mental Health Counselor | MN | |
| Mental Health Counselor | MN | |
| Mental Health Counselor | WI | |
| Clinical Social Worker | WI | |
| Mental Health Counselor | WI |
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