Provider Demographics
NPI:1033849062
Name:HEAL FROM WITHIN
Entity Type:Organization
Organization Name:HEAL FROM WITHIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RUMMEL
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-774-2264
Mailing Address - Street 1:6401 205TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:WI
Mailing Address - Zip Code:53104-9730
Mailing Address - Country:US
Mailing Address - Phone:847-774-2264
Mailing Address - Fax:
Practice Address - Street 1:6401 205TH AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:WI
Practice Address - Zip Code:53104-9730
Practice Address - Country:US
Practice Address - Phone:847-774-2264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty