Healthcare Provider Details

I. General information

NPI: 1629915608
Provider Name (Legal Business Name): LITTLE MINDS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E GREEN BAY ST STE 101
SHAWANO WI
54166-2444
US

IV. Provider business mailing address

PO BOX 115
WITTENBERG WI
54499-0115
US

V. Phone/Fax

Practice location:
  • Phone: 715-280-8130
  • Fax: 715-280-8138
Mailing address:
  • Phone: 715-701-0476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA BADDMOCCOSIN-BARNES
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 715-701-0476