Healthcare Provider Details

I. General information

NPI: 1528923802
Provider Name (Legal Business Name): WILDERNESS & WONDER COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 N ALPINE RD STE 403
ROCKFORD IL
61107-1440
US

IV. Provider business mailing address

1639 N ALPINE RD STE 403
ROCKFORD IL
61107-1440
US

V. Phone/Fax

Practice location:
  • Phone: 608-492-1992
  • Fax:
Mailing address:
  • Phone: 608-492-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY BAYLOR
Title or Position: LCPC
Credential: LCPC
Phone: 608-492-1992