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NPI Code Detail

MEDICARE: VLW LLC

MEDICARE: VLW 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)3061MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336628478
Entity Type Code : Organization
Provider Name (Legal Business Name) : VLW LLC
Provider Business Mailing Address
First Line : 8578 DUNKIRK CT NE
Second Line :
City : BLAINE
State : MN
Zip : 55449-6789
Country : US
Telephone Number : 612-799-6652
Fax Number :
Provider Business Practice Location Address
First Line : 4255 PHEASANT RIDGE DR NE STE 412
Second Line :
City : BLAINE
State : MN
Zip : 55449-5066
Country : US
Telephone Number : 612-799-6652
Fax Number :
Authorized Official
Title or Position : CEO
Name : AMANDA ADELL WIRTH
Credential : LMFT
Telephone Number : 612-799-6652
Provider Enumeration Date : 08/09/2018
Last Update Date : 11/17/2021

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Directions to “VLW LLC ” Practice Location

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