HEIDI JO HATHAWAY (PSYD, LP) – Clinical Psychologist, NPI 1780755256
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,110 CLINICAL PSYCHOLOGIST in MN
Provider Addresses for HEIDI JO HATHAWAY (PSYD, LP)
4027 County Road 25
Minneapolis, MN 554162629
Phone: (612) 925-6033
Fax: (612) 925-8496
Type: Location
Coon Rapids Boulevard Northwest, Parkside, Coon Rapids, Anoka County, Minnesota, 55434, United States
SUITE 120
COON RAPIDS, MN 554332643
Phone: (763) 767-3350
Fax: (763) 767-0912
Type: Location
4240 PARK GLEN RD
ST LOUIS PARK, MN 554165427
Phone: (612) 925-6033
Fax: (612) 925-8496
Type: Mailing
6200 SHINGLE CREEK PKWY STE 350
BROOKLYN CENTER, MN 554302155
Phone: (763) 503-8560
Fax: (763) 503-8563
Type: Location
1900, Silver Lake Road Northwest, New Brighton, Ramsey County, Minnesota, 55112, United States
SUITE 110
NEW BRIGHTON, MN 551121786
Phone: (651) 628-9566
Fax: (651) 628-0411
Type: Mailing
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: 2008-08-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20080827000592 | I | Clinical Psychologist | MN | 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 55416)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MN | |
| - | MN | |
| Clinical Social Worker | MN | |
| Clinical Social Worker | WI | |
| - | MN | |
| - | MN | |
| - | MN | |
| Clinical Psychologist | MN | |
| Clinical Social Worker | MN | |
| - | MN |
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