| NPI | 1184419228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIE JON BATA Owner 218-297-1900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2025-04-10 |
| Last Update Date | 2025-07-21 |