Provider Demographics
NPI:1174350078
Name:PLAYFUL HEALING, LLC
Entity type:Organization
Organization Name:PLAYFUL HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-448-2322
Mailing Address - Street 1:134 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1715
Mailing Address - Country:US
Mailing Address - Phone:651-448-2322
Mailing Address - Fax:
Practice Address - Street 1:105 UNION ST S STE 3
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1592
Practice Address - Country:US
Practice Address - Phone:651-448-2322
Practice Address - Fax:651-448-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1609530716Medicaid