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General NPI Number Information
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NPI Number | 1982477105
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Entity Type | Organization
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Legal Business Name | WILD HEART WELLNESS PLLC
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 101 S JAMES ST STE 204
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City | LUDINGTON
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State | MI
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Zip | 49431-2166
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Country | US
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Telephone | 231-233-3111
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Fax | 231-410-1014
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Provider Business Mailing Address
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Address Line | 101 S JAMES ST STE 204
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City | LUDINGTON
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State | MI
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Zip | 49431-2166
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Country | US
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Telephone | 231-233-3111
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Fax | 231-410-1014
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER M SWANGER
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Credential |
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Telephone | 231-233-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 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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