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General NPI Number Information
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NPI Number | 1780479246
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Entity Type | Organization
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Legal Business Name | WILD ZEN LLC
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 2379 N BAILEY RD
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City | CORAL
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State | MI
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Zip | 49322-9754
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Country | US
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Telephone | 616-648-0444
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Fax |
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Provider Business Mailing Address
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Address Line | 2379 N BAILEY RD
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City | CORAL
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State | MI
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Zip | 49322-9754
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Country | US
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Telephone | 616-648-0444
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Fax |
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Authorized Official
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Title or Position | DOULA
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Name | CARRIE L LABARGE
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Credential | DOULA, CBS, LCE, RYT
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Telephone | 616-648-0444
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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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