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General NPI Number Information
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NPI Number | 1588575245
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Entity Type | Organization
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Legal Business Name | NOURISHING CHANGE
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 1476 KENWOOD DR STE 102
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City | MENASHA
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State | WI
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Zip | 54952-1134
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Country | US
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Telephone | 920-939-8868
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Fax | 920-939-7042
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Provider Business Mailing Address
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Address Line | 1476 KENWOOD DR STE 102
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City | MENASHA
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State | WI
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Zip | 54952-1134
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Country | US
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Telephone | 920-939-8868
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Fax | 920-939-7042
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | AMY MEGAN TAAKE
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Credential | LPC, SAC
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Telephone | 920-939-8868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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