Healthcare Provider Details

I. General information

NPI: 1912748674
Provider Name (Legal Business Name): EVERY LITTLE FIBER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BISHOPS WAY STE 156
BROOKFIELD WI
53005-6271
US

IV. Provider business mailing address

2925 N 124TH ST
BROOKFIELD WI
53005-3803
US

V. Phone/Fax

Practice location:
  • Phone: 815-651-6174
  • Fax:
Mailing address:
  • Phone: 815-651-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAYLOR ASHLEY PRELLBERG
Title or Position: OWNER
Credential: RD
Phone: 815-651-6174