Healthcare Provider Details

I. General information

NPI: 1750161295
Provider Name (Legal Business Name): ONYX PATHWAYS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 03/10/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 WHITEWATER DR STE 100
MINNETONKA MN
55343-9347
US

IV. Provider business mailing address

12800 WHITEWATER DR STE 100
MINNETONKA MN
55343-9347
US

V. Phone/Fax

Practice location:
  • Phone: 952-856-0405
  • Fax:
Mailing address:
  • Phone: 952-856-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: SIERRA NICOLE CARTER
Title or Position: OWNER
Credential: LICSW
Phone: 952-856-0405