Healthcare Provider Details

I. General information

NPI: 1295818862
Provider Name (Legal Business Name): WOODLAND CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 6TH ST SE
WILLMAR MN
56201-0787
US

IV. Provider business mailing address

1125 6TH ST SE
WILLMAR MN
56201-0787
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-4613
  • Fax: 320-231-9140
Mailing address:
  • Phone: 320-235-4613
  • Fax: 320-231-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number802665
License Number StateMN

VIII. Authorized Official

Name: DR. ASHLEY KJOS
Title or Position: CEO
Credential:
Phone: 320-235-4613