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General NPI Number Information
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NPI Number | 1942622865
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Entity Type | Organization
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Legal Business Name | NORTH NODE WELLNESS, INC.
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Dates
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Enumeration Date | 01/11/2014
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Last Update Date | 01/11/2014
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Provider Practice Location Address
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Address Line | 8701 WATERWOOD CT
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City | FORT WAYNE
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State | IN
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Zip | 46804-8410
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Country | US
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Telephone | 260-705-4395
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 WATERWOOD CT
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City | FORT WAYNE
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State | IN
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Zip | 46804-8410
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Country | US
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Telephone | 260-705-4395
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | KIMBERLY A BAILEY
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Credential | LCSW
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Telephone | 260-705-4395
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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 | 34005563A
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License Number State | IN
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