MEDICARE: PINK COUCH WELLNESS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1316637275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINK COUCH WELLNESS

Provider Business Mailing Address
First Line	:	1220 NE STATION XING STE 114
Second Line	:
City	:	GRIMES
State	:	IA
Zip	:	50111-8013
Country	:	US
Telephone Number	:	515-680-6516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 NE STATION XING STE 114
Second Line	:
City	:	GRIMES
State	:	IA
Zip	:	50111-8013
Country	:	US
Telephone Number	:	515-680-6516
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VANESSA ANDERSEN
Credential	:	LISW
Telephone Number	:	515-380-6516

Provider Enumeration Date	:	05/12/2023
Last Update Date	:	05/12/2023

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Directions to “PINK COUCH WELLNESS ” Practice Location

Language	Start Address	Practice Location

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