Healthcare Provider Details

I. General information

NPI: 1396668851
Provider Name (Legal Business Name): STACY HATKE MSW, LICSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 27TH AVE S STE 244
MINNEAPOLIS MN
55406-3197
US

IV. Provider business mailing address

1918 CLINTON AVE UNIT 1
MINNEAPOLIS MN
55404-2747
US

V. Phone/Fax

Practice location:
  • Phone: 612-759-5580
  • Fax:
Mailing address:
  • Phone: 612-759-5580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number32518
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: