Healthcare Provider Details

I. General information

NPI: 1174474506
Provider Name (Legal Business Name): DEERE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 32ND AVE S STE E
GRAND FORKS ND
58201-6021
US

IV. Provider business mailing address

2355 310TH ST
HALLOCK MN
56728-9507
US

V. Phone/Fax

Practice location:
  • Phone: 218-988-0062
  • Fax:
Mailing address:
  • Phone: 218-988-0062
  • 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: KYLIE DEERE
Title or Position: OWNER
Credential: LCSW
Phone: 218-988-0062