Provider Demographics
NPI:1306389861
Name:EDGES WELLNESS CENTER
Entity Type:Organization
Organization Name:EDGES WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:IANTAFFI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-483-5726
Mailing Address - Street 1:730 E 38TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2572
Mailing Address - Country:US
Mailing Address - Phone:612-483-5726
Mailing Address - Fax:855-545-4632
Practice Address - Street 1:730 E 38TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2572
Practice Address - Country:US
Practice Address - Phone:612-483-5726
Practice Address - Fax:855-545-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MN2061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty