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General NPI Number Information
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NPI Number | 1174350078
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Entity Type | Organization
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Legal Business Name | PLAYFUL HEALING, LLC
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Dates
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Enumeration Date | 09/16/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 105 UNION ST S STE 3
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City | MORA
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State | MN
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Zip | 55051-1592
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Country | US
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Telephone | 651-448-2322
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Fax | 651-448-2322
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Provider Business Mailing Address
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Address Line | 134 RIVERSIDE ST
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City | MORA
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State | MN
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Zip | 55051-1715
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Country | US
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Telephone | 651-448-2322
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | SARA RENEE KENNEDY
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Credential |
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Telephone | 651-448-2322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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