Provider Demographics
NPI:1306260005
Name:PATHWAYS TO WELLNESS MINNESOTA LTD.
Entity type:Organization
Organization Name:PATHWAYS TO WELLNESS MINNESOTA LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BAUMGARDNER BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:612-474-1700
Mailing Address - Street 1:1409 WILLOW ST STE 109
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2241
Mailing Address - Country:US
Mailing Address - Phone:612-474-1700
Mailing Address - Fax:612-474-1710
Practice Address - Street 1:1409 WILLOW ST STE 109
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2241
Practice Address - Country:US
Practice Address - Phone:612-474-1700
Practice Address - Fax:612-474-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-15
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1681251S00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000152564Medicaid