NPIMap

Organization Active NPI

Healthwise Psychology, PA

  • Clinical Psychologist
  • Maple Grove, MN
National Provider Identifier
1184920753
Registry record updated May 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
HEALTHWISE PSYCHOLOGY, PA
Practice address
11280 86TH Ave N
Maple Grove, MN 55369-4510
Phone
(763) 400-7828
Fax
(763) 400-7444
NPI assigned
Jan 31, 2011
Last updated
May 29, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2014

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

Authorized official

Name
Dr. Kristin B Dahl, PSYD, LPNPI 1134382914
Title
Licensed Psychologist/Owner
Phone
(612) 599-5197

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X MN Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X MN

Addresses

Primary practice location

11280 86TH Ave N
Maple Grove, MN 55369-4510

Mailing address

11280 86TH Ave N
Maple Grove, MN 55369-4510
Phone (763) 400-7828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140516001784 MN Part B Supplier - Clinic/Group Practice 2567685647 Receives reassigned benefits from 53 practitioners
Practice locations: Maple Grove, MN; Plymouth, MN

National Provider Directory

National Provider Directory

Locations

11280 86th Ave N
Maple Grove, MN 55369
Phone (763) 400-7828

18205 45th Ave N
Plymouth, MN 55446
Phone (763) 400-7828

Practitioners & affiliated clinicians

Practitioners 64

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1296432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401321600000",
    "number": "1184920753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11280 86TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694510",
            "telephone_number": "763-400-7828",
            "fax_number": "763-400-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11280 86TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694510",
            "telephone_number": "763-400-7828",
            "fax_number": "763-400-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHWISE PSYCHOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-31",
        "last_updated": "2014-05-29",
        "status": "A",
        "authorized_official_last_name": "DAHL",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "612-599-5197",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, LP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.