Healthcare Provider Details

I. General information

NPI: 1821908690
Provider Name (Legal Business Name): STILL BLOOM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 AMERICAN DR STE A4.5
NEENAH WI
54956-1236
US

IV. Provider business mailing address

1907 AMERICAN DR STE A4.5
NEENAH WI
54956-1236
US

V. Phone/Fax

Practice location:
  • Phone: 920-525-1266
  • Fax: 920-214-1077
Mailing address:
  • Phone: 920-525-1266
  • Fax: 920-214-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JAYCIE WESTPHAL
Title or Position: OWNER
Credential: LPC
Phone: 920-525-1266