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General NPI Number Information
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NPI Number | 1669144135
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Entity Type | Organization
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Legal Business Name | BADGER WELLNESS
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 2810 CROSSROADS DR SUITE 4000 #1827
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City | MADISON
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State | WI
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Zip | 53718
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Country | US
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Telephone | 608-345-5684
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 CROSSROADS DR SUITE 4000 #1827
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City | MADISON
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State | WI
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Zip | 53718
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Country | US
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Telephone | 608-345-5684
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | BRENDAN MICHAEL ROE
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Credential |
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Telephone | 608-345-5684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical 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 | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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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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