| Willow Tree Healing Center, Llc | |
|
1821 University Ave W Suite S329 Saint Paul MN 55104-2801 | |
| (651) 222-9885 | |
| (888) 977-2056 |
| Full Name | Willow Tree Healing Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1821 University Ave W, Saint Paul, Minnesota |
| Authorized Official Name and Position | Tracey Wilkins (CLINICAL SERVICES DIRECTOR) |
| Authorized Official Contact | 6512229985 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Tree Healing Center, Llc 1821 University Ave Suite S329 St Paul MN 55104 Ph: (651) 222-9885 | Willow Tree Healing Center, Llc 1821 University Ave W Suite S329 Saint Paul MN 55104-2801 Ph: (651) 222-9885 |
| NPI Number | 1912149345 |
|---|---|
| Provider Enumeration Date | 03/31/2009 |
| Last Update Date | 02/19/2015 |
| Medicare PECOS PAC ID | 4486979762 |
|---|---|
| Medicare Enrollment ID | O20150209000179 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912149345 | NPI | - | NPPES |
| 312174700 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 13119 (Minnesota) | Primary |
| 1041C0700X | Social Worker - Clinical | 15043 (Minnesota) | Secondary |
| Provider Name | Tracey L Wilkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598858359 PECOS PAC ID: 1052473782 Enrollment ID: I20081215000365 |
| Provider Name | Kandee K Timmerman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437248713 PECOS PAC ID: 9133396286 Enrollment ID: I20120113000031 |
| Provider Name | Hilary L Mueller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740468354 PECOS PAC ID: 1658459078 Enrollment ID: I20190405000001 |
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