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NPI Code Detail

MEDICARE: VITAL ROOTS WELLNESS LLC

MEDICARE: VITAL ROOTS WELLNESS 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
1106H00000XMarriage & Family Therapist
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1851259170
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITAL ROOTS WELLNESS LLC
Provider Business Mailing Address
First Line : 1622 N 48TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-2247
Country : US
Telephone Number : 262-337-2746
Fax Number :
Provider Business Practice Location Address
First Line : 1622 N 48TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-2247
Country : US
Telephone Number : 262-337-2746
Fax Number :
Authorized Official
Title or Position : OWNER/PSYCHOTHERAPIST
Name : TODD M THOMAS
Credential : LCSW LMFT
Telephone Number : 414-200-9275
Provider Enumeration Date : 01/14/2026
Last Update Date : 01/14/2026

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Directions to “VITAL ROOTS WELLNESS LLC ” Practice Location

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