Healthcare Provider Details

I. General information

NPI: 1073429916
Provider Name (Legal Business Name): IVY PATH WELLNESS & THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 REGENT ST APT C
STEVENS POINT WI
54481-2200
US

IV. Provider business mailing address

3508 REGENT ST APT C
STEVENS POINT WI
54481-2200
US

V. Phone/Fax

Practice location:
  • Phone: 630-429-5536
  • Fax:
Mailing address:
  • Phone: 630-429-5536
  • 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: MAEGAN C BAULER
Title or Position: THERAPIST/OWNER
Credential: MSW, LCSW
Phone: 630-429-5536