HEIDI JO HATHAWAY PSYD LP NPI 1780755256

NPI Information

  • NPI: 1780755256
  • Provider Name: HEIDI JO HATHAWAY, PSYD, LP
  • Classification: Psychologist - 103TC0700X
  • Specialization: Clinical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 6200 SHINGLE CREEK PKWY STE 350
    BROOKLYN CENTER, MN
    ZIP 55430
  • Phone: (763) 503-8560

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NPI Details

Heidi Jo Hathaway, PSYD, LP is a clinical psychologist in Brooklyn Center, MN with 30 years of experience. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. Heidi Jo Hathaway, PSYD, LP NPI is 1780755256. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

6200 SHINGLE CREEK PKWY STE 350
BROOKLYN CENTER, MN
ZIP 55430-155
Phone: (763) 503-8560
Fax: (763) 503-8563

The NPI 1780755256 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 11/13/2006 and was last updated on 2/2/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TC0700XPsychologistClinicalLP3930MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1123494OTHERMINNESOTAUCARE
261-34863OTHERMINNESOTAMEDICA
3050385100MEDICAIDMICRONESIA
411R21REOTHERMINNESOTABLUECROSSBLUESHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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