Healthcare Provider Details

I. General information

NPI: 1699691139
Provider Name (Legal Business Name): WILLOW TREE WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 ARDMORE DR
FERNDALE MI
48220-3319
US

IV. Provider business mailing address

261 ARDMORE DR
FERNDALE MI
48220-3319
US

V. Phone/Fax

Practice location:
  • Phone: 313-513-0517
  • Fax:
Mailing address:
  • Phone: 313-513-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURIE VELTRI
Title or Position: PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 419-708-5158