MEDICARE: OPEN SKY THERAPY AND 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1376164848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN SKY THERAPY AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	302 W SUPERIOR ST STE 511
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-5115
Country	:	US
Telephone Number	:	218-321-1880
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 W SUPERIOR ST STE 511
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-5115
Country	:	US
Telephone Number	:	218-321-1880
Fax Number	:

Authorized Official
Title or Position	:	LICSW
Name	:	MICHELE JOY FLATAU
Credential	:	LICSW
Telephone Number	:	218-321-1880

Provider Enumeration Date	:	05/06/2020
Last Update Date	:	01/14/2026

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