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General NPI Number Information
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NPI Number | 1609710128
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Entity Type | Organization
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Legal Business Name | EVERGREEN THERAPY AND WELLNESS PLLC
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Dates
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Enumeration Date | 04/15/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 2477 CLARE LN NE STE 400A
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City | ROCHESTER
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State | MN
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Zip | 55906-8417
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Country | US
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Telephone | 530-868-6944
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Fax |
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Provider Business Mailing Address
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Address Line | 2477 CLARE LN NE STE 400A
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City | ROCHESTER
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State | MN
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Zip | 55906-8417
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Country | US
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Telephone | 530-868-6944
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER S LARSON
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Credential |
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Telephone | 530-868-6944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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