Healthcare Provider Details

I. General information

NPI: 1851259170
Provider Name (Legal Business Name): VITAL ROOTS WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 N 48TH ST
MILWAUKEE WI
53208-2247
US

IV. Provider business mailing address

1622 N 48TH ST
MILWAUKEE WI
53208-2247
US

V. Phone/Fax

Practice location:
  • Phone: 262-337-2746
  • Fax:
Mailing address:
  • Phone: 262-337-2746
  • 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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: TODD M THOMAS
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW, LICSW, LMFT
Phone: 414-200-9275