Provider Demographics
NPI:1083167340
Name:MAPLEWOOD WELLNESS CENTER OF MINNESOTA
Entity Type:Organization
Organization Name:MAPLEWOOD WELLNESS CENTER OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA, LMFT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-329-1266
Mailing Address - Street 1:2103 COUNTY ROAD D E STE A
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5357
Mailing Address - Country:US
Mailing Address - Phone:651-329-1266
Mailing Address - Fax:
Practice Address - Street 1:2103 COUNTY ROAD D E STE A
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5357
Practice Address - Country:US
Practice Address - Phone:651-329-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty