| Illumination, Llc | |
|
1660 Highway 100 S Suite 502 St Louis Park MN 55416-1529 | |
| (612) 239-6017 | |
| Not Available |
| Full Name | Illumination, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1660 Highway 100 S, St Louis Park, Minnesota |
| Authorized Official Name and Position | Sarah Gravelle Thoeny (OWNER) |
| Authorized Official Contact | 6122396017 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illumination, Llc 1660 Highway 100 S Suite 502 St Louis Park MN 55416-1529 Ph: (612) 239-6017 | Illumination, Llc 1660 Highway 100 S Suite 502 St Louis Park MN 55416-1529 Ph: (612) 239-6017 |
| NPI Number | 1194140749 |
|---|---|
| Provider Enumeration Date | 02/19/2014 |
| Last Update Date | 02/19/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194140749 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2150 (Minnesota) | Primary |
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