MEDICARE: WANDERING WELL COUNSELING AND CONSULTING 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1205666351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WANDERING WELL COUNSELING AND CONSULTING LLC

Provider Business Mailing Address
First Line	:	4418 BEARD AVE S APT 305
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-4001
Country	:	US
Telephone Number	:	774-219-2156
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 ROSE PL
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-2802
Country	:	US
Telephone Number	:	763-292-3859
Fax Number	:	763-272-7273

Authorized Official
Title or Position	:	OWNER
Name	:	JILLIAN MICHELLE WALKER
Credential	:
Telephone Number	:	774-219-2156

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	03/02/2026

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