| Organization Name: | WILDSONG WELLNESS LLC |
| NPI Number: | 1083080527 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACQULYN LAUER-GLEBOV (ACUPUNCTURIST) |
| Mailing Address: | 5 E Eau Claire St Rice Lake |
| State: | WI US |
| Postal Code: | 548681747 |
| Phone Number: | 7157361014 |
| Fax Number: | 7157361014 |
| NPI Enumeration Date: | 08/19/2015 |
| NPI Last Update Date: | 08/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 55-830 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |