Healthcare Provider Details

I. General information

NPI: 1982582698
Provider Name (Legal Business Name): WISE & WELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E MAIN ST
MANCHESTER MI
48158-8748
US

IV. Provider business mailing address

PO BOX 96
MANCHESTER MI
48158-0096
US

V. Phone/Fax

Practice location:
  • Phone: 734-386-0633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE MCCLURE
Title or Position: MENTAL HEALTH THERAPIST
Credential: LMSW
Phone: 734-707-6763