Healthcare Provider Details

I. General information

NPI: 1437039617
Provider Name (Legal Business Name): WHITE PINES PLAY COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2025
Last Update Date: 09/06/2025
Certification Date: 09/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E JAMES ST
ELY MN
55731-1343
US

IV. Provider business mailing address

14 E JAMES ST
ELY MN
55731-1343
US

V. Phone/Fax

Practice location:
  • Phone: 218-656-0293
  • Fax:
Mailing address:
  • Phone: 218-656-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. MOLLY ELIZABETH SLOVNIK
Title or Position: THERAPIST
Credential: LICSW
Phone: 218-656-0293