Provider Demographics
NPI:1255131553
Name:EAGLE WOODS WELLNESS
Entity type:Organization
Organization Name:EAGLE WOODS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORRIN
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-581-4557
Mailing Address - Street 1:1260 BLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2005
Mailing Address - Country:US
Mailing Address - Phone:507-581-4557
Mailing Address - Fax:
Practice Address - Street 1:1260 BLAIR AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2005
Practice Address - Country:US
Practice Address - Phone:507-581-4557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)