Provider Demographics
NPI:1003587916
Name:WILDWOOD HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:WILDWOOD HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAYLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CEDERGREN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-205-2720
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MN
Mailing Address - Zip Code:56080-0459
Mailing Address - Country:US
Mailing Address - Phone:507-205-2720
Mailing Address - Fax:507-205-9673
Practice Address - Street 1:45 WINNEBAGO CIRCLE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MN
Practice Address - Zip Code:56080
Practice Address - Country:US
Practice Address - Phone:507-995-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health