=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962642884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYNERGISTIC HEALING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2009
-----------------------------------------------------
Last Update Date | 03/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1511 E MINNESOTA ST
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56374-8618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-363-4223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1511 E MINNESOTA ST PO BOX 33
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56374-8618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-363-4223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | JANELLE J HINCHLEY
-----------------------------------------------------
Credential | MSW LICSW
-----------------------------------------------------
Telephone | 320-363-4223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 10027
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------