Healthcare Provider Details

I. General information

NPI: 1205576709
Provider Name (Legal Business Name): HOLISTIC DOWL HOUSE HEALTH & WELLNESS HEALING CLUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6830 W VILLARD AVE STE 100
MILWAUKEE WI
53218
US

IV. Provider business mailing address

6830 W VILLARD AVE STE 100
MILWAUKEE WI
53218
US

V. Phone/Fax

Practice location:
  • Phone: 877-593-3695
  • Fax:
Mailing address:
  • Phone: 877-593-3695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE DOWL
Title or Position: OWNER
Credential:
Phone: 414-335-4427