Healthcare Provider Details

I. General information

NPI: 1952279614
Provider Name (Legal Business Name): WILDFLOWER WELLNESS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 CHESHIRE DR NE STE C
GRAND RAPIDS MI
49505-4102
US

IV. Provider business mailing address

545 CHESHIRE DR NE STE C
GRAND RAPIDS MI
49505-4102
US

V. Phone/Fax

Practice location:
  • Phone: 616-209-9058
  • Fax:
Mailing address:
  • Phone: 616-209-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: EMILY SALZMAN
Title or Position: THERAPIST/OWNER
Credential: LMSW
Phone: 616-209-9058