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General NPI Number Information
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NPI Number | 1578356564
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Entity Type | Organization
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Legal Business Name | WILDLY ROOTED THERAPY SERVICES
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 37272 20TH AVE
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City | DENNISON
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State | MN
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Zip | 55018-7425
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Country | US
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Telephone | 505-235-2827
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Fax |
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Provider Business Mailing Address
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Address Line | 37272 20TH AVE
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City | DENNISON
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State | MN
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Zip | 55018-7425
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Country | US
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Telephone | 505-235-2827
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL LEAD
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Name | LINDSEY J ZEMANEK
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Credential | LMFT
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Telephone | 505-235-2827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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