| Industrious Healing Llc | |
|
10501 Wayzata Blvd Ste 204 Minnetonka MN 55305-1519 | |
| (612) 219-7620 | |
| Not Available |
| Full Name | Industrious Healing Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10501 Wayzata Blvd Ste 204, Minnetonka, Minnesota |
| Authorized Official Name and Position | Emily J Laconic (OWNER, THERAPIST) |
| Authorized Official Contact | 6122197620 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Industrious Healing Llc 4908 Aldrich Ave N Minneapolis MN 55430-3533 Ph: (612) 219-7620 | Industrious Healing Llc 10501 Wayzata Blvd Ste 204 Minnetonka MN 55305-1519 Ph: (612) 219-7620 |
| NPI Number | 1114575982 |
|---|---|
| Provider Enumeration Date | 08/26/2019 |
| Last Update Date | 12/07/2019 |
| Certification Date | 12/07/2019 |
| Medicare PECOS PAC ID | 1052642006 |
|---|---|
| Medicare Enrollment ID | O20191007000932 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114575982 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Emily J Laconic |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437652518 PECOS PAC ID: 5991068405 Enrollment ID: I20180416002355 |
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