Provider Demographics
NPI:1215373469
Name:WILLOW WOOD WELLNESS CLINIC INC.
Entity Type:Organization
Organization Name:WILLOW WOOD WELLNESS CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-432-1228
Mailing Address - Street 1:928 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-2955
Mailing Address - Country:US
Mailing Address - Phone:515-432-1228
Mailing Address - Fax:515-432-1239
Practice Address - Street 1:928 7TH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-2955
Practice Address - Country:US
Practice Address - Phone:515-432-1228
Practice Address - Fax:515-432-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty