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General NPI Number Information
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NPI Number | 1952190290
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Entity Type | Organization
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Legal Business Name | SPROUTED BEAN PEDIATRICS AND WELLNESS LLC
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Dates
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Enumeration Date | 05/03/2025
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | N63W23675 MAIN ST
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City | SUSSEX
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State | WI
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Zip | 53089-3977
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Country | US
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Telephone | 612-237-2746
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Fax |
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Provider Business Mailing Address
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Address Line | W233N7735 CHESTNUT CT
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City | SUSSEX
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State | WI
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Zip | 53089-1522
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Country | US
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Telephone | 612-237-2746
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SABRINA MICHELLE FOULKS-THOMAS
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Credential | RN, CPM, LM, IBCLC
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Telephone | 612-237-2746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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