MEDICARE: WILDFLOWER COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1578021341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILDFLOWER COUNSELING

Provider Business Mailing Address
First Line	:	219 WALDO AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-4550
Country	:	US
Telephone Number	:	308-850-6397
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 N LOCUST ST STE 201
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-6107
Country	:	US
Telephone Number	:	308-380-0027
Fax Number	:

Authorized Official
Title or Position	:	LIMHP
Name	:	STEPHANIE ANNE SAYLOR-BLE
Credential	:	MA
Telephone Number	:	308-380-0027

Provider Enumeration Date	:	03/11/2019
Last Update Date	:	09/03/2024

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