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General NPI Number Information
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NPI Number | 1194547364
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Entity Type | Organization
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Legal Business Name | WELLNESS WITH WANDER, LLC
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 15135 OGDEN LOOP STE 204
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City | ODESSA
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State | FL
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Zip | 33556-4633
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Country | US
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Telephone | 412-576-9304
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Fax |
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Provider Business Mailing Address
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Address Line | 16316 DOVETAIL WAY
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City | SPRING HILL
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State | FL
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Zip | 34610-6512
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Country | US
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Telephone | 412-576-9304
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | JESSICA JUDD
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Credential | MS, LMHC, PMH-C
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Telephone | 412-576-9304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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