1437515160 NPI number — INNER WISDOM THERAPY AND HEALING ARTS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437515160 NPI number — INNER WISDOM THERAPY AND HEALING ARTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNER WISDOM THERAPY AND HEALING ARTS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437515160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 973
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALENT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97540-0973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-948-9243
Provider Business Mailing Address Fax Number:
541-631-2599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 WILLIAMSON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-948-9243
Provider Business Practice Location Address Fax Number:
541-631-2599
Provider Enumeration Date:
01/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KOVOLISKY
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-948-9243

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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