Healthcare Provider Details

I. General information

NPI: 1427859248
Provider Name (Legal Business Name): AJA HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 W MILL RD
MILWAUKEE WI
53218-1147
US

IV. Provider business mailing address

2656 N TEUTONIA AVE UNIT 6566
MILWAUKEE WI
53206-3421
US

V. Phone/Fax

Practice location:
  • Phone: 262-229-9258
  • Fax:
Mailing address:
  • Phone: 262-229-9258
  • 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: SHANICE BAUET
Title or Position: MANGER
Credential: PHD
Phone: 262-229-9258