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Organization
VLW LLC
Active
Organization
VLW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA ADELL WIRTH LMFT (CEO)
(612) 799-6652
Entity
Organization
Contact information
Practice address
4255 PHEASANT RIDGE DR NE STE 412, BLAINE, MN 55449-5066
(612) 799-6652
Mailing address
8578 DUNKIRK CT NE, BLAINE, MN 55449-6789
(612) 799-6652
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
3061
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5724462
—
MN
Enumeration date
08/09/2018
Last updated
11/17/2021
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