| De Ella D Wilcox Llc | |
|
433 27th Ave N Saint Cloud MN 56303-3745 | |
| (218) 639-2805 | |
| Not Available |
| Full Name | De Ella D Wilcox Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 433 27th Ave N, Saint Cloud, Minnesota |
| Authorized Official Name and Position | De Ella Dawn Wilcox (MANAGER/OWNER) |
| Authorized Official Contact | 2186392805 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| De Ella D Wilcox Llc 433 27th Ave N Saint Cloud MN 56303-3745 Ph: (218) 639-2805 | De Ella D Wilcox Llc 433 27th Ave N Saint Cloud MN 56303-3745 Ph: (218) 639-2805 |
| NPI Number | 1396451241 |
|---|---|
| Provider Enumeration Date | 01/24/2023 |
| Last Update Date | 01/24/2023 |
| Certification Date | 01/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396451241 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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