| Old Growth Healing Llc | |
|
220 Division St S Ste 2 Northfield MN 55057-2046 | |
| (952) 457-3469 | |
| Not Available |
| Full Name | Old Growth Healing Llc |
|---|---|
| Speciality | Social Worker |
| Location | 220 Division St S Ste 2, Northfield, Minnesota |
| Authorized Official Name and Position | Katie Jacobi (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 9524573469 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Growth Healing Llc 220 Division St S Northfield MN 55057-2046 Ph: (952) 457-3469 | Old Growth Healing Llc 220 Division St S Ste 2 Northfield MN 55057-2046 Ph: (952) 457-3469 |
| NPI Number | 1659064293 |
|---|---|
| Provider Enumeration Date | 05/30/2023 |
| Last Update Date | 05/30/2023 |
| Certification Date | 05/30/2023 |
| Medicare PECOS PAC ID | 9739548876 |
|---|---|
| Medicare Enrollment ID | O20230707000036 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659064293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Katie Jean Jacobi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164962957 PECOS PAC ID: 8123304417 Enrollment ID: I20171114001378 |
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