Samantha Lynn Klockow, PSYD, LP is a medicare enrolled "Psychologist - Clinical" provider in Lakeville, Minnesota. She graduated from healthcare school in 2018 and has 7 years of diverse experience with area of expertise as Clinical Psychologist. She is a member of the group practice Wisconsin Lutheran Child And Family Service Inc and her current practice location is
8670 210th St W, Lakeville, Minnesota. You can reach out to her office (for appointments etc.) via phone at
(800) 438-1772.
Samantha Lynn Klockow is licensed to practice in Wisconsin (license number 3983-57) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1457860884.
Healthcare Provider's Profile
| Full Name | Samantha Lynn Klockow |
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| Gender | Female |
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| Speciality | Clinical Psychologist |
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| Experience | 7 Years |
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| Location | 8670 210th St W, Lakeville, Minnesota |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Samantha Lynn Klockow graduated from medical school in 2018
NPI Data:
- NPI Number: 1457860884
- Provider Enumeration Date: 09/28/2017
- Last Update Date: 09/28/2021
Medicare PECOS Information:
- PECOS PAC ID: 0042640641
- Enrollment ID: I20210723002079
Medical Identifiers
Medical identifiers for Samantha Lynn Klockow such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1457860884 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | 6493 (Minnesota) | Secondary |
| 103TC0700X | Psychologist - Clinical | 3983-57 (Wisconsin) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Wisconsin Lutheran Child And Family Service Inc | 0749233898 | 31 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Samantha Lynn Klockow allows following entities to bill medicare on her behalf.
| Entity Name | Wisconsin Lutheran Child And Family Service Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1083786628
PECOS PAC ID: 0749233898
Enrollment ID: O20050301000318 |
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| Entity Name | Brightside Medical Pa |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1609335660
PECOS PAC ID: 3678948809
Enrollment ID: O20230525002664 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Samantha Lynn Klockow is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Samantha Lynn Klockow, PSYD, LP
W175n11120 Stonewood Dr,
Germantown, WI 53022-4799
Ph: (800) 438-1772 | Samantha Lynn Klockow, PSYD, LP
8670 210th St W,
Lakeville, MN 55044-7000
Ph: (800) 438-1772 |
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