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General NPI Number Information
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NPI Number | 1750192050
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Entity Type | Organization
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Legal Business Name | WILLOW WELLBEING, LLC
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 6417 PENN AVE S STE 7-1440
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City | MINNEAPOLIS
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State | MN
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Zip | 55423-1186
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Country | US
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Telephone | 763-233-1298
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Fax |
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Provider Business Mailing Address
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Address Line | 6417 PENN AVE S STE 7-1440
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City | MINNEAPOLIS
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State | MN
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Zip | 55423-1186
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MICHAEELA BRANDS
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Credential | RD, LD
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Telephone | 763-233-1298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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