Provider Demographics
NPI:1093533218
Name:SECOND WIND WELLNESS LLC
Entity type:Organization
Organization Name:SECOND WIND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:419-913-6373
Mailing Address - Street 1:445 EARLWOOD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-2744
Mailing Address - Country:US
Mailing Address - Phone:419-407-6758
Mailing Address - Fax:
Practice Address - Street 1:445 EARLWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-2744
Practice Address - Country:US
Practice Address - Phone:419-407-6758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty