Healthcare Provider Details

I. General information

NPI: 1750248548
Provider Name (Legal Business Name): MEADOWLARK SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17039 72ND AVE N
MAPLE GROVE MN
55311-4564
US

IV. Provider business mailing address

17039 72ND AVE N
MAPLE GROVE MN
55311-4564
US

V. Phone/Fax

Practice location:
  • Phone: 507-469-2084
  • Fax:
Mailing address:
  • Phone: 507-469-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SANKO
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW, LICSW
Phone: 507-469-2084