Provider Demographics
NPI:1437786175
Name:HEATHER KOLWICH WELLNESS LLC
Entity Type:Organization
Organization Name:HEATHER KOLWICH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLWICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-797-1765
Mailing Address - Street 1:21764 CORSAUT LN
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2606
Mailing Address - Country:US
Mailing Address - Phone:248-797-1765
Mailing Address - Fax:
Practice Address - Street 1:21764 CORSAUT LN
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-2606
Practice Address - Country:US
Practice Address - Phone:248-797-1765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech