Provider Demographics
NPI:1760054068
Name:EVOLVING WELLNESS CORP
Entity Type:Organization
Organization Name:EVOLVING WELLNESS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BERNDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-523-0617
Mailing Address - Street 1:2645 HARLEM ST STE 1T
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2504
Mailing Address - Country:US
Mailing Address - Phone:715-514-4233
Mailing Address - Fax:
Practice Address - Street 1:2645 HARLEM ST STE 1T
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2504
Practice Address - Country:US
Practice Address - Phone:715-514-4233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center