| Stellar Wellness | |
|
1065 24th Ave Sw Ste 107 Owatonna MN 55060-5063 | |
| (507) 774-3147 | |
| Not Available |
| Full Name | Stellar Wellness |
|---|---|
| Speciality | Social Worker |
| Location | 1065 24th Ave Sw Ste 107, Owatonna, Minnesota |
| Authorized Official Name and Position | Tara Kay Jeno (OWNER) |
| Authorized Official Contact | 5074566123 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stellar Wellness 3 Augusta Pl Owatonna MN 55060-2100 Ph: (507) 456-6123 | Stellar Wellness 1065 24th Ave Sw Ste 107 Owatonna MN 55060-5063 Ph: (507) 774-3147 |
| NPI Number | 1912536814 |
|---|---|
| Provider Enumeration Date | 04/03/2020 |
| Last Update Date | 04/03/2020 |
| Certification Date | 04/03/2020 |
| Medicare PECOS PAC ID | 5597195982 |
|---|---|
| Medicare Enrollment ID | O20200427001681 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912536814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tara K Jeno |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649728395 PECOS PAC ID: 1759678386 Enrollment ID: I20160927000096 |
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