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General NPI Number Information
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NPI Number | 1891685376
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Entity Type | Organization
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Legal Business Name | MINDFUL BALANCE INTEGRATED WEIGHT LOSS AND WELLNESS
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 6032 40TH AVE
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City | KENOSHA
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State | WI
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Zip | 53142-7018
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Country | US
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Telephone | 262-900-8186
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Fax | 262-287-0884
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Provider Business Mailing Address
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Address Line | 6032 40TH AVE
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City | KENOSHA
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State | WI
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Zip | 53142-7018
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Country | US
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Telephone | 262-900-8186
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Fax | 262-287-0884
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DANA BOOE-DRAPER
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Credential |
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Telephone | 262-287-1999
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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