Provider Demographics
NPI:1316816804
Name:WOODLAND WELLNESS LLC
Entity type:Organization
Organization Name:WOODLAND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CACOPARDO
Authorized Official - Suffix:
Authorized Official - Credentials:CPS
Authorized Official - Phone:620-704-3972
Mailing Address - Street 1:4406 W 28TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-8117
Mailing Address - Country:US
Mailing Address - Phone:620-704-3972
Mailing Address - Fax:
Practice Address - Street 1:4406 W 28TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-8117
Practice Address - Country:US
Practice Address - Phone:620-704-3972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty