MEDICARE: SUNFLOWER THERAPY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1093502098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNFLOWER THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	2855 ANTHONY LN S STE 201
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-2637
Country	:	US
Telephone Number	:	651-318-0001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 ANTHONY LN S STE 201
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-2637
Country	:	US
Telephone Number	:	651-318-0001
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MADELEINE LOUISE CALHOON BAILLIE
Credential	:	LICSW
Telephone Number	:	651-403-3989

Provider Enumeration Date	:	04/22/2025
Last Update Date	:	04/22/2025

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