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General NPI Number Information
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NPI Number | 1659211258
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Entity Type | Organization
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Legal Business Name | WILDFLOWER COLLECTIVE
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 2931 IMPERIAL CT
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2210
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Country | US
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Telephone | 312-288-5690
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Fax |
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Provider Business Mailing Address
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Address Line | 2931 IMPERIAL CT
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2210
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MIALAUNI GRIGGS-HOLKE
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Credential | PHD, LMFT
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Telephone | 773-726-7497
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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