| Woodhaven Wellness Llc | |
|
30 1st Ave Ne Buffalo MN 55313-1515 | |
| (763) 478-7395 | |
| Not Available |
| Full Name | Woodhaven Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 30 1st Ave Ne, Buffalo, Minnesota |
| Authorized Official Name and Position | Mary G. Mattison-wynn (CEO) |
| Authorized Official Contact | 7634787395 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Woodhaven Wellness Llc 3000 Carriage Dr Hamel MN 55340-9597 Ph: (763) 478-7395 | Woodhaven Wellness Llc 30 1st Ave Ne Buffalo MN 55313-1515 Ph: (763) 478-7395 |
| NPI Number | 1124639190 |
|---|---|
| Provider Enumeration Date | 08/13/2020 |
| Last Update Date | 04/01/2021 |
| Certification Date | 04/01/2021 |
| Medicare PECOS PAC ID | 2961819289 |
|---|---|
| Medicare Enrollment ID | O20210401000879 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124639190 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mary Mattison-wynn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649202755 PECOS PAC ID: 2466450143 Enrollment ID: I20081119000074 |
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