MEDICARE: DEERE WELLNESS 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1174474506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEERE WELLNESS LLC

Provider Business Mailing Address
First Line	:	3001A 32ND AVE S STE 3A
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-6067
Country	:	US
Telephone Number	:	701-757-0743
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 32ND AVE S STE E
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-6021
Country	:	US
Telephone Number	:	218-988-0062
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KYLIE DEERE
Credential	:	LCSW
Telephone Number	:	218-988-0062

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	04/28/2026

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Directions to “DEERE WELLNESS LLC ” Practice Location

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