Healthcare Provider Details

I. General information

NPI: 1639613912
Provider Name (Legal Business Name): WHOLE CHILD WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 W JACKSON BLVD
SPEARFISH SD
57783-1909
US

IV. Provider business mailing address

1014 VERDALE DR
SPEARFISH SD
57783-1641
US

V. Phone/Fax

Practice location:
  • Phone: 605-388-2993
  • Fax: 605-388-2993
Mailing address:
  • Phone: 605-388-2993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CARLY MESSNER
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 605-388-2993