Healthcare Provider Details

I. General information

NPI: 1205746575
Provider Name (Legal Business Name): BLOOMING WILD COLLECTIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 4TH ST STE 220
SIOUX CITY IA
51101-1930
US

IV. Provider business mailing address

1119 4TH ST STE 220
SIOUX CITY IA
51101-1930
US

V. Phone/Fax

Practice location:
  • Phone: 712-847-2226
  • Fax:
Mailing address:
  • Phone: 712-847-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELLY SACHAU
Title or Position: OWNER; CLINICIAN
Credential: LHMC
Phone: 712-847-2226