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General NPI Number Information
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NPI Number | 1205666351
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Entity Type | Organization
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Legal Business Name | WANDERING WELL COUNSELING AND CONSULTING LLC
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Dates
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Enumeration Date | 08/05/2024
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 5174 COUNTRY RD
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City | HERMANTOWN
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State | MN
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Zip | 55810-9748
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Country | US
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Telephone | 763-292-3859
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Fax | 763-272-7273
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Provider Business Mailing Address
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Address Line | 2050 AIRPORT RD APT 204
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City | KALISPELL
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State | MT
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Zip | 59901-5854
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Country | US
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Telephone | 774-219-2156
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JILLIAN MICHELLE WALKER
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Credential |
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Telephone | 774-219-2156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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