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MARY LYNN HENDRICKSON PSY.D., LP
NPI 1164569612
Psychologist - Clinical in Minnetonka, MN

Active since January 31, 2007Opted out of Medicare · through Dec 23, 2026
11900 WAYZATA BLVD, SUITE 216, MINNETONKA, MN 55305(952) 546-0700(952) 546-0700 Get Directions Write a Review

NPPES record last updated: July 9, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mary Lynn Hendrickson Psy.d., Lp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY LYNN HENDRICKSON PSY.D., LP (NPI 1164569612) is an individual clinical provider in Minnetonka, Minnesota, licensed in Minnesota (LP3184) and active in the NPI registry since January 2007. She has opted out of Medicare through December 23, 2026.

NPPES Registry Identity

NPI1164569612
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameMARY LYNN HENDRICKSONCredential: PSY.D., LP
Location Address11900 WAYZATA BLVD, SUITE 216Minnetonka, MN 55305-2031
Mailing Address11900 Wayzata Blvd, Suite 216Minnetonka, MN 55305-2031 · (952) 546-0700 · Fax (952) 546-0700
Phone(952) 546-0700
Fax(952) 546-0700
Sole ProprietorYes
Enumeration DateJanuary 31, 2007
Last NPPES UpdateJuly 9, 2007
✔ NPI 1164569612 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in MN · LP3184
Definition
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.
11900 WAYZATA BLVD, Minnetonka, MN 55305
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Other Identifiers 1

Medicare UPIN7H354HEMN

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Mary Lynn Hendrickson Psy.d., Lp has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 23, 2024 through December 23, 2026.

Opt-Out Effective DateDecember 23, 2024
Opt-Out In Effect ThroughDecember 23, 2026Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. SUSAN B. GARFIELD LISCW, ACSW
Social Worker (Clinical)
11900 WAYZATA BLVD, STE 209
MINNETONKA, MN 55305
Hennepin County (952) 746-7894
JENNIFER BENNETT M.S., L.P.
Psychologist
11900 WAYZATA BLVD, SUITE 214
MINNETONKA, MN 55305
Hennepin County (952) 446-7933
MR. GREGORY RIPLEY L.AC.
Acupuncturist
11900 WAYZATA BLVD, SUITE 110
MINNETONKA, MN 55305
Hennepin County (612) 804-3804
DR. GRETCHEN RANEE LEWIS-SNYDER L.P
Psychologist
11900 WAYZATA BLVD, SUITE 216E
MINNETONKA, MN 55305
Hennepin County (612) 719-5422
SONDRA L BLASCHKO
Behavior Technician
11900 WAYZATA BLVD
MINNETONKA, MN, MN 55305
Hennepin County (612) 413-8780
DR. SUSAN E SUNDELL PH.D.,L.P
Psychologist (Clinical)
11900 WAYZATA BLVD, SUITE 112
MINNETONKA, MN 55305
Hennepin County (612) 272-0800
DAWN MCKEE
Massage Therapist
11900 WAYZATA BLVD, SUITE 110
MINNETONKA, MN 55305
Hennepin County (952) 297-6936
JOAN W. LALLY LICSW
Social Worker (Clinical)
11900 WAYZATA BLVD, SUITE 200
MINNETONKA, MN 55305
Hennepin County (952) 270-4040

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Hendrickson's NPI number?

The NPI number for Mary Hendrickson is 1164569612. It was assigned to this individual provider in the NPPES registry on January 31, 2007.

Where is Mary Hendrickson located?

Mary Hendrickson practices at 11900 Wayzata Blvd Suite 216, Minnetonka, MN 55305. The listed phone number is (952) 546-0700.

What is Mary Hendrickson's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Mary Hendrickson enrolled in Medicare?

No. Mary Hendrickson has opted out of Medicare through December 23, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Mary Hendrickson was last updated on July 9, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.