Provider Demographics
NPI:1558090738
Name:WILDFLOWER EXPRESSIVE ARTS THERAPIES LLC
Entity type:Organization
Organization Name:WILDFLOWER EXPRESSIVE ARTS THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOLTZIEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ATR
Authorized Official - Phone:608-520-0846
Mailing Address - Street 1:3600 CARNCROSS DR
Mailing Address - Street 2:
Mailing Address - City:MCFARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-9617
Mailing Address - Country:US
Mailing Address - Phone:608-217-8757
Mailing Address - Fax:
Practice Address - Street 1:700 RAYOVAC DR.
Practice Address - Street 2:SUITE 320
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-5371
Practice Address - Country:US
Practice Address - Phone:608-520-0846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932672003OtherNPPES