MEDICARE: SYNERGISTIC HEALING

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	10027	MN

Other Identifiers

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

General Provider Information

NPI Number	:	1962642884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGISTIC HEALING

Provider Business Mailing Address
First Line	:	1511 E MINNESOTA ST
Second Line	:	PO BOX 33
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-8618
Country	:	US
Telephone Number	:	320-363-4223
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 E MINNESOTA ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-8618
Country	:	US
Telephone Number	:	320-363-4223
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JANELLE J HINCHLEY
Credential	:	MSW LICSW
Telephone Number	:	320-363-4223

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	03/05/2009

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