| Water Of Life | |
|
6 E 45th St Minneapolis MN 55419-5026 | |
| (612) 220-2757 | |
| (612) 435-1400 |
| Full Name | Water Of Life |
|---|---|
| Speciality | Social Worker |
| Location | 6 E 45th St, Minneapolis, Minnesota |
| Authorized Official Name and Position | Kelsey Kreider Starrs (OWNER) |
| Authorized Official Contact | 6122202757 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Water Of Life 4732 Colfax Ave S Minneapolis MN 55419-5318 Ph: (612) 220-2757 | Water Of Life 6 E 45th St Minneapolis MN 55419-5026 Ph: (612) 220-2757 |
| NPI Number | 1194222489 |
|---|---|
| Provider Enumeration Date | 04/12/2018 |
| Last Update Date | 04/05/2021 |
| Certification Date | 04/05/2021 |
| Medicare PECOS PAC ID | 8224386149 |
|---|---|
| Medicare Enrollment ID | O20180808002286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194222489 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 19329 (Minnesota) | Primary |
| Provider Name | Kelsey S Kreiderstarrs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871897355 PECOS PAC ID: 7719154236 Enrollment ID: I20120124000096 |
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