Provider Demographics
NPI:1194514406
Name:WINGS WELLNESS LLC
Entity type:Organization
Organization Name:WINGS WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOMPMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-552-1367
Mailing Address - Street 1:17640 MORSE ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1420
Mailing Address - Country:US
Mailing Address - Phone:219-552-1367
Mailing Address - Fax:
Practice Address - Street 1:17640 MORSE ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1420
Practice Address - Country:US
Practice Address - Phone:219-552-1367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty