# WILDFLOWER THERAPY SERVICES

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487355020
- **Authorized official:** JESSICA MAGNUSON (OWNER)
- **Authorized official phone:** (763) 200-1215

## Contact information

- **Practice address:** 13750 CROSSTOWN DR NW STE 102, ANDOVER, MN 55304-5855
- **Practice address phone:** (763) 200-1215
- **Mailing address:** 13750 CROSSTOWN DR NW STE 102, ANDOVER, MN 55304-5855
- **Mailing address phone:** (763) 200-1215

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/10/2023
- **Last updated:** 08/29/2024