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General NPI Number Information
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NPI Number | 1689503500
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Entity Type | Organization
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Legal Business Name | WILD ROOTS BIRTH COLLECTIVE LLC
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Dates
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Enumeration Date | 05/16/2026
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Last Update Date | 05/16/2026
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Provider Practice Location Address
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Address Line | 1164A E GANNON DR
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City | FESTUS
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State | MO
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Zip | 63028-2604
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Country | US
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Telephone | 573-944-1832
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Fax |
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Provider Business Mailing Address
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Address Line | 14268 SPRING DR
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City | DE SOTO
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State | MO
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Zip | 63020-5146
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Country | US
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Telephone | 573-944-1832
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JACQUELYNE LIVENGOOD
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Credential | CD
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Telephone | 573-944-1832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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