Healthcare Provider Details

I. General information

NPI: 1568324457
Provider Name (Legal Business Name): MIND, YONI & SOUL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2025
Last Update Date: 11/29/2025
Certification Date: 11/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 W CAPITOL DR
MILWAUKEE WI
53222-1532
US

IV. Provider business mailing address

6033 N 38TH ST
MILWAUKEE WI
53209-3612
US

V. Phone/Fax

Practice location:
  • Phone: 414-501-8257
  • Fax:
Mailing address:
  • Phone: 414-501-8257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE C WILKINS
Title or Position: OWNER
Credential:
Phone: 414-501-8257