MEDICARE: WILLOWROOT WELLNESS COLLECTIVE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1326971912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOWROOT WELLNESS COLLECTIVE, LLC

Provider Business Mailing Address
First Line	:	21 SHADY CREEK LN
Second Line	:
City	:	AMELIA
State	:	OH
Zip	:	45102-1765
Country	:	US
Telephone Number	:	513-739-0289
Fax Number	:	513-739-0289

Provider Business Practice Location Address
First Line	:	21 SHADY CREEK LN
Second Line	:
City	:	AMELIA
State	:	OH
Zip	:	45102-1765
Country	:	US
Telephone Number	:	513-739-0289
Fax Number	:	513-739-0289

Authorized Official
Title or Position	:	OWNER
Name	:	KATHERINE LEE SWOPE
Credential	:	M.ED., LPCC-S
Telephone Number	:	513-739-0289

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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