MEDICARE: WILLOWCO COLLECTIVE LEARNING LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1679226328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOWCO COLLECTIVE LEARNING LLC

Provider Business Mailing Address
First Line	:	13249 CARR RIDGE RD
Second Line	:
City	:	SILVER POINT
State	:	TN
Zip	:	38582-6025
Country	:	US
Telephone Number	:	931-201-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	13249 CARR RIDGE RD
Second Line	:
City	:	SILVER POINT
State	:	TN
Zip	:	38582-6025
Country	:	US
Telephone Number	:	931-201-9222
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	APRIL FEDEROFF
Credential	:
Telephone Number	:	931-201-9222

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	02/02/2022

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