| Grapevine Clinical Llc | |
|
666 Walnut St Ste 1610 Des Moines IA 50309-3974 | |
| (515) 360-0034 | |
| (844) 381-0919 |
| Full Name | Grapevine Clinical Llc |
|---|---|
| Speciality | Social Worker |
| Location | 666 Walnut St Ste 1610, Des Moines, Iowa |
| Authorized Official Name and Position | Wendy Tillgren (OWNER) |
| Authorized Official Contact | 5153690034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grapevine Clinical Llc 666 Walnut St Ste 1610 Des Moines IA 50309-3974 Ph: () - | Grapevine Clinical Llc 666 Walnut St Ste 1610 Des Moines IA 50309-3974 Ph: (515) 360-0034 |
| NPI Number | 1952837809 |
|---|---|
| Provider Enumeration Date | 05/11/2017 |
| Last Update Date | 07/26/2022 |
| Certification Date | 07/26/2022 |
| Medicare PECOS PAC ID | 5294008397 |
|---|---|
| Medicare Enrollment ID | O20170912003283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952837809 | NPI | - | NPPES |
| Provider Name | Wendy Tillgren |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245533348 PECOS PAC ID: 1254518335 Enrollment ID: I20110527000433 |
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