Provider Demographics
NPI:1053827477
Name:ROOTS AND WINGS THERAPY
Entity type:Organization
Organization Name:ROOTS AND WINGS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LISW / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-637-6659
Mailing Address - Street 1:15838 HIGHWAY K42
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IA
Mailing Address - Zip Code:51063-8745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15838 HIGHWAY K42
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IA
Practice Address - Zip Code:51063-8745
Practice Address - Country:US
Practice Address - Phone:402-637-6659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)