Individual provider Active NPI

Katelyn Hejna

  • Professional Counselor
  • Andover, MN
National Provider Identifier
1164803748
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
CC01000 Issued in MN
Practice address
1875 Station Pkwy NW
Andover, MN 55304-3319
Phone
(612) 413-6629
NPI assigned
Jun 9, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X CC01000 MN Primary

Addresses

Primary practice location

1875 Station Pkwy NW
Andover, MN 55304-3319

Mailing address

1875 Station Pkwy NW
Andover, MN 55304-3319

Other names 1

  • Katelyn Gardner Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240229001885 MN Practitioner - Mental Health Counselor 1658721758 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CC01000MNMDProfessional Counselor
1000MNMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Rum River Counseling, Inc. Professional CurrentSince Jan 16, 2024 Accepting new patients
Nystrom & Associates, LTD PastSince Jul 1, 2013 Accepting new patients
Family Support Services Inc. PastSince Mar 3, 2024 Accepting new patients

Locations

1875 Station Pkwy NW
Andover, MN 55304

11090 183rd Cir NW
Ste A
Elk River, MN 55330
Phone (763) 691-3430

7200 Hudson Blvd N
Ste 220
Oakdale, MN 55128

18205 45th Ave N
Ste D
Plymouth, MN 55446
Phone (214) 554-4089

14115 James Rd
Ste 305
Rogers, MN 55374
Phone (763) 575-8086

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1164803748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043319",
            "telephone_number": "612-413-6629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEJNA",
        "first_name": "KATELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-09",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "GARDNER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Andover, MN

Sources for this page

Verify at the official NPI Registry.