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General NPI Number Information
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NPI Number | 1013537836
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Entity Type | Organization
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Legal Business Name | GOLDEN MEND WELLNESS AND COUNSELING
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 122 E OLIN AVE STE 220
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City | MADISON
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State | WI
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Zip | 53713-1482
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Country | US
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Telephone | 608-729-8696
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 NEW TOWN DR APT 310
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-7082
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Country | US
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Telephone | 608-217-1262
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA GRANTMAN
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Credential | LCSW
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Telephone | 608-729-8696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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