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General NPI Number Information
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NPI Number | 1225929896
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Entity Type | Organization
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Legal Business Name | LAVENDER & IVY WELLNESS LLC
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 121 E MAIN ST FL 3
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City | MADISON
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State | WI
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Zip | 53703-3351
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Country | US
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Telephone | 608-389-0148
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 FORDEM AVE APT 304
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City | MADISON
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State | WI
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Zip | 53704-7137
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Country | US
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Telephone | 651-302-3496
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL PSYCHOTHERAPIST
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Name | VICTORIA ROSE DIETZ
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Credential | APSW
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Telephone | 651-302-3496
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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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