Healthcare Provider Details

I. General information

NPI: 1699699454
Provider Name (Legal Business Name): HEALED TO SOAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N MAIN ST
CADOTT WI
54727-9501
US

IV. Provider business mailing address

508 N MAIN ST
CADOTT WI
54727-9501
US

V. Phone/Fax

Practice location:
  • Phone: 715-255-1212
  • Fax:
Mailing address:
  • Phone: 715-225-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE BOWE
Title or Position: LPC
Credential: MA
Phone: 715-225-1212