Provider Demographics
NPI:1518733534
Name:SPROUT MIDWEST WELLNESS PLLC
Entity Type:Organization
Organization Name:SPROUT MIDWEST WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:320-200-0552
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56240-0128
Mailing Address - Country:US
Mailing Address - Phone:320-200-0552
Mailing Address - Fax:320-287-7001
Practice Address - Street 1:221 STUDDART AVE
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56240-0128
Practice Address - Country:US
Practice Address - Phone:320-200-0552
Practice Address - Fax:320-287-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty