Individual provider Active NPI

Jean Heitzman, LICSW

  • Clinical Social Worker
  • Grand Rapids, MN
National Provider Identifier
1780871418
Registry record updated Nov 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
35382 US Highway 2
Grand Rapids, MN 55744-4754
Phone
(218) 327-4886
NPI assigned
Sep 26, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X MN Primary

Addresses

Primary practice location

35382 US Highway 2
Grand Rapids, MN 55744-4754

Mailing address

104 NE 3Rd St
# 200H
Grand Rapids, MN 55744-2869

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
I20080211000582 MN Practitioner - Clinical Social Worker 5698858850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
New Beginnings Counseling LLCGroup PAC ID 9638501661, 3 clinicians

Practice addresses (Care Compare)

104 NE 3Rd St
200H
Grand Rapids, MN 55744-2869
Phone (218) 999-7081

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
New Beginnings Counseling LLC CurrentSince Oct 7, 2019 Accepting new patients

Locations

204 2nd St NW
Aitkin, MN 56431
Phone (218) 330-4303

104 NE 3rd St
Ste 200H
Grand Rapids, MN 55744

104 NE 3rd St
#200H
Grand Rapids, MN 55744
Phone (218) 259-5566

104 NE 3rd St
Grand Rapids, MN 55744
Phone (218) 301-7226

Organizations & group practices 1

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": "1190764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572912000000",
    "number": "1780871418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 NE 3RD ST",
            "address_2": "# 200H",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557442869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35382 US HIGHWAY 2",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557444754",
            "telephone_number": "218-327-4886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEITZMAN",
        "first_name": "JEAN",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-26",
        "last_updated": "2019-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MN

Sources for this page

Verify at the official NPI Registry.