Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Heather Gallivan

Individual provider Psychologist · NPI 1477538247

Heather Gallivan is a Clinical Psychologist in Minneapolis, Minnesota. Qualified in 2002, 24 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
24
Licensed in
MN
In the registry since
2005
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Practice location Address checks out

6490 Excelsior Blvd Ste W505
Minneapolis, MN 55426-4705
Phone: (952) 993-6200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychologist (primary) Taxonomy 103T00000X · Licence LP4521 (MN)

Record details

NPI number1477538247
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 14, 2005
Last updated in NPPESJuly 13, 2026
Mailing address6465 Wayzata Blvd, Suite 315, St Louis Park, MN 55426-1728

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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