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General NPI Number Information
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NPI Number | 1669288452
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Entity Type | Organization
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Legal Business Name | SHEPHERD WELLNESS, LLC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 14332 21ST AVE N STE 200
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City | PLYMOUTH
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State | MN
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Zip | 55447-4566
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Country | US
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Telephone | 612-564-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 4190 VINEWOOD LANE N STE 111 PMB 403
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City | PLYMOUTH
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State | MN
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Zip | 55442
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Country | US
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Telephone | 612-564-9355
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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 SHEPHERD
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Credential |
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Telephone | 612-564-9355
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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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