WILD EARTH WELLNESS (NPI# 1285159251) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285159251 |
| Entity Type | Organization |
| Organization Name | WILD EARTH WELLNESS |
| Practice Address |
24850 Se Stark St Ste 200 Gresham OR 97030-8320 |
| Practice Telephone | (503) 310-2622 |
| Mailing Telephone | 5033102622 |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2017-08-10 |
| Authorized Official Name | MRS. JENNIFER MARIE BOOM (OWNER) |
| Authorized Official Telephone | 5033102622 |
| Authorized Official Credential | LMT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
7615 | OR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NPI | 1164547634 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | WILD EARTH WELLNESS | 24850 Se Stark St, Suite 200, Gresham, OR 97030 |
| Street Address |
24850 SE STARK ST STE 200 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-8320 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629219613 | Lorita Elaine Johnson | Mechanotherapist | 24850 Se Stark St Ste 200, Gresham, OR 97030-8320 | 2009-03-20 |
| 1326499666 | Julie Shiprack | Advanced Practice Midwife | 24850 Se Stark St Ste 200, Gresham, OR 97030-8320 | 2016-06-28 |
| 1558777342 | Britta Ameel | Obstetrics & Gynecology | 24850 Se Stark St Ste 200, Gresham, OR 97030-8320 | 2014-07-01 |
| 1982041703 | Kirsten Gwynn | Advanced Practice Midwife | 24850 Se Stark St Ste 200, Gresham, OR 97030-8320 | 2013-06-03 |
| 1770809303 | Audra Rachelle Norris-jacob | Obstetrics & Gynecology | 24850 Se Stark St Ste 200, Gresham, OR 97030-8320 | 2010-04-07 |
| 1992039309 | Monica Elizabeth Venn | Obstetrics & Gynecology | 24850 Se Stark St Ste 200, Gresham, OR 97030-8320 | 2009-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538681408 | Golden Ribbon Acupuncture, LLC | Clinic/Center | 1217 Ne Burnside Rd Ste 701, Gresham, OR 97030-5770 | 2017-07-12 |
| 1831484633 | Anderson Therapeutic Massage Clinic | Clinic/Center | 655 Nw Burnside Rd Ste 1, Gresham, OR 97030-3745 | 2011-06-09 |
| 1831721489 | Docere Naturopathic Medicine LLC | Clinic/Center | 500 Nw 20th St, Gresham, OR 97030-2441 | 2020-02-11 |
| 1821388687 | Bodies In Balance Chiropractic LLC | Clinic/Center | 1748 Nw Fairview Dr, Gresham, OR 97030-3842 | 2011-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225665623 | Onlinevisit LLC | Clinic/Center | 2024 Sw Howards Way Apt 501, Portland, OR 97201-7726 | 2020-03-25 |
| 1407492002 | Oregon Injection Clinic | Clinic/Center | 1500 Nw Lovejoy, 106, Portland, OR 97209 | 2019-11-19 |
| 1801452818 | Everybody Wellness, LLC | Clinic/Center | 2143 Ne Broadway St Ste 9, Portland, OR 97232-1512 | 2019-05-15 |
| 1801451737 | Cephus Chiropractic LLC | Clinic/Center | 19755 Sw Tv Hwy, Aloha, OR 97003-2338 | 2019-05-06 |
| 1467934661 | Columbia River Health-pendleton High School Sbhc | Clinic/Center | 1800 Nw Carden Ave, Pendleton, OR 97801-1185 | 2018-09-04 |
| 1639651839 | Columbia River Health-sunridge Middle School Sbhc | Clinic/Center | 700 Sw Runnion Ave, Pendleton, OR 97801-9418 | 2018-09-04 |
| 1114433802 | Thriving Acupuncture | Clinic/Center | 1708 Nw 25th Ave Apt 6, Portland, OR 97210-2435 | 2017-12-18 |
| 1316468341 | Accident Care Chiropractic and Massage of Salem | Clinic/Center | 2168 Lancaster Dr. Ne, Portland, OR 97216 | 2017-06-29 |
| 1417484460 | Be Well Acupuncture | Clinic/Center | 3125 Ne Holladay St # B, Portland, OR 97232-2504 | 2017-05-20 |
| 1811441652 | Boly Health and Education, LLC | Clinic/Center | 2607 Nw Thurman St, Portland, OR 97210-2202 | 2016-08-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.