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General NPI Number Information
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NPI Number | 1295557213
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Entity Type | Organization
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Legal Business Name | MOONFLOWER LLC
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 5445 CITY HALL ST
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City | NISSWA
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State | MN
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Zip | 56468-2478
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Country | US
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Telephone | 218-820-1023
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Fax |
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Provider Business Mailing Address
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Address Line | 7601 CHANNEL LN
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City | PILLAGER
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State | MN
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Zip | 56473-8001
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Country | US
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Telephone | 218-820-1023
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Fax |
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Authorized Official
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Title or Position | DR. DSW LICSW OWNER/OPERATOR
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Name | DR. MALLORI ANN SHEIK
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Credential | DSW, LICSW
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Telephone | 218-820-1023
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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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