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General NPI Number Information
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NPI Number | 1942057153
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Entity Type | Organization
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Legal Business Name | WILLOW WELLNESS INC
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Dates
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Enumeration Date | 05/04/2024
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 475 ETNA ST STE 24
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City | SAINT PAUL
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State | MN
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Zip | 55106-5935
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Country | US
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Telephone | 651-300-4733
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Fax | 651-430-1750
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Provider Business Mailing Address
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Address Line | 475 ETNA ST STE 24
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City | SAINT PAUL
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State | MN
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Zip | 55106-5935
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Country | US
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Telephone | 651-300-4733
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Fax | 651-430-1750
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Authorized Official
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Title or Position | CEO
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Name | ZAKAREYA HASSAN
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Credential |
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Telephone | 651-300-4733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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