Organization
WILLOW AND COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHIRLEY A MUCK COSMETOLOGIST (OWNER)
(605) 645-0071
Entity
Organization
Contact information
Practice address
1845 CHRISTENSEN DR, SPEARFISH, SD 57783-8041
(605) 645-0071
Mailing address
1845 CHRISTENSEN DR, SPEARFISH, SD 57783-8041
(605) 645-0071
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CS-03854-2008
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002588
WELLMARK
SD
Enumeration date
04/17/2008
Last updated
06/23/2008
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