Hathaway, Heidi Jo
Hathaway, Heidi Jo is an individual health care provider with primary practice located at 6200 Shingle Creek Pkwy Ste 350 , Brooklyn Center MN 55430-2155. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Hathaway, Heidi Jo can be contacted via phone (763) 503-8560.Contact Information
Primary practice address
6200 Shingle Creek Pkwy Ste 350
Brooklyn Center MN 55430-2155
Phone: (763) 503-8560
Fax: (763) 503-8563
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | LP3930 | Minnesota |
Profile Details
| NPI number | 1780755256 |
|---|---|
| LBN Legal business name | Hathaway, Heidi Jo |
| Credentials | PSYD, LP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 13th, 2006 |
| Last updated | Feb 2nd, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780755256 | NPPES |
| Minnesota | Other | 123494 | UCARE |
| Minnesota | Other | 61-34863 | UCARE |
| Minnesota | MEDICAID | 050385100 | UCARE |
| Minnesota | Other | 11R21RE | UCARE |
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