Healthcare Provider Details

I. General information

NPI: 1093479057
Provider Name (Legal Business Name): WOODNOTE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 S WASHINGTON ST
GRAND FORKS ND
58201-6339
US

IV. Provider business mailing address

1913 S WASHINGTON ST STE C
GRAND FORKS ND
58201-6339
US

V. Phone/Fax

Practice location:
  • Phone: 701-317-6590
  • Fax:
Mailing address:
  • Phone: 701-757-1425
  • Fax: 701-299-0695

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER MAGELKY
Title or Position: BILLING CONSULTANT
Credential:
Phone: 218-329-2705