NPI Code Detail JSON Logo

1285447292 NPI number — NORTHERN WOODS WELLNESS LLC

NPI Number: 1285447292
Health Care Provider/Practitioner: NORTHERN WOODS WELLNESS LLC

Information about “1285447292” NPI (NORTHERN WOODS WELLNESS LLC) exists in 1285447292 in HTML format HTML  |  1285447292 in plain Text format TXT  |  1285447292 in PDF (Portable Document Format) PDF  |  1285447292 in an XML format XML  formats.

NPI Number : 1285447292 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285447292",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NORTHERN WOODS WELLNESS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1235A MENOMONIE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAU CLAIRE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54703-5974",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "715-598-1568",
    "MailingAddressFaxNumber": "715-800-0104",
    "FirstLinePracticeLocationAddress": "1235A MENOMONIE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EAU CLAIRE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54703-5974",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "715-598-1568",
    "PracticeLocationAddressFaxNumber": "715-800-0104",
    "EnumerationDate": "01/31/2025",
    "LastUpdateDate": "07/03/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FOSTER",
    "AuthorizedOfficialFirstName": "TIMOTHY",
    "AuthorizedOfficialMiddleName": "RYAN",
    "AuthorizedOfficialTitle": "OWNER/THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MA, LPC",
    "AuthorizedOfficialTelephoneNumber": "715-600-1966",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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