MEDICARE: WELL FED CO. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1003687518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELL FED CO. LLC

Provider Business Mailing Address
First Line	:	3209 BENT TREE DR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-9033
Country	:	US
Telephone Number	:	972-839-0262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1257 2ND ST N
Second Line	:
City	:	SAUK RAPIDS
State	:	MN
Zip	:	56379-4595
Country	:	US
Telephone Number	:	320-761-1666
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERIKA L YANCEY
Credential	:	DC, IBCLC
Telephone Number	:	972-839-0262

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	01/12/2024

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Directions to “WELL FED CO. LLC ” Practice Location

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