Healthcare Provider Details

I. General information

NPI: 1336953827
Provider Name (Legal Business Name): SERVANTS HEART HEALTH AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11695 42ND ST SE
CLEAR LAKE MN
55319-9813
US

IV. Provider business mailing address

PO BOX 32
CLEAR LAKE MN
55319-0032
US

V. Phone/Fax

Practice location:
  • Phone: 651-341-0299
  • Fax:
Mailing address:
  • Phone: 651-341-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTY WOLF
Title or Position: OWNER
Credential: DNP, FNP, PMHNP
Phone: 651-341-0299