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General NPI Number Information
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NPI Number | 1285447292
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Entity Type | Organization
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Legal Business Name | NORTHERN WOODS WELLNESS LLC
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 1235A MENOMONIE ST
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5974
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Country | US
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Telephone | 715-598-1568
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Fax | 715-800-0104
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Provider Business Mailing Address
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Address Line | 1235A MENOMONIE ST
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5974
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Country | US
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Telephone | 715-598-1568
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Fax | 715-800-0104
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | TIMOTHY RYAN FOSTER
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Credential | MA, LPC
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Telephone | 715-600-1966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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