| Wild Fern Clinical Therapy Pllc | |
|
3620 Wesley Ave Berwyn IL 60402-3861 | |
| (616) 212-8957 | |
| Not Available |
| Full Name | Wild Fern Clinical Therapy Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3620 Wesley Ave, Berwyn, Illinois |
| Authorized Official Name and Position | Elise Johnston Dumerauf (OWNER) |
| Authorized Official Contact | 6162128957 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Fern Clinical Therapy Pllc 3620 Wesley Ave Berwyn IL 60402-3861 Ph: (616) 212-8957 | Wild Fern Clinical Therapy Pllc 3620 Wesley Ave Berwyn IL 60402-3861 Ph: (616) 212-8957 |
| NPI Number | 1346084829 |
|---|---|
| Provider Enumeration Date | 06/20/2024 |
| Last Update Date | 08/25/2024 |
| Certification Date | 08/25/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346084829 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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