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Active NPI 1285159251 Organization (Entity Type 2)

Wild Earth Wellness

Clinic/Center - Health Service • Gresham, OR

About Wild Earth Wellness NPI 1285159251 Summary

Wild Earth Wellness is a verified healthcare organization specializing in Clinic/Center - Health Service operating in Gresham, OR. Located at 24850 SE STARK ST STE 200, this facility provides patient care and medical services under National Provider Identifier (NPI) 1285159251.

Administrative operations and authorized compliance are overseen by Jennifer Boom (Owner).

The facility is associated with 14 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

24850 Se Stark St Ste 200

Gresham, OR 970308320

Telephone 5033102622

Authorized Official Information

Authorized Contact Name

MRS. Jennifer Boom , LMT

Title / Role

Owner

Official Telephone

5033102622

Facility Classifications & Specialties

Clinic/Center - Health Service Primary Taxonomy

NUCC Taxonomy Code: 261QH0100X

Definition to come...

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

14 Linked
Jessica Hargadine NPI 1124851811

Advanced Practice Midwife

Gresham, OR

View Practitioner Profile →

Advanced Practice Midwife

Gresham, OR

View Practitioner Profile →

Advanced Practice Midwife

Gresham, OR

View Practitioner Profile →
Julie Shiprack , CNM NPI 1326499666

Advanced Practice Midwife

Gresham, OR

View Practitioner Profile →
Julia Curren , CNM NPI 1336403468

Advanced Practice Midwife

Gresham, OR

View Practitioner Profile →

Advanced Practice Midwife

Gresham, OR

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events
NPI Profile Active August 10, 2017

NPI status registered as active in NPPES database

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Updated Practice Location August 10, 2017

Registered at 24850 SE STARK ST STE 200, GRESHAM, OR 970308320 (Tel: (503) 310-2622)

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Updated Business Mailing Address August 10, 2017

Registered at 24850 SE STARK ST STE 200, GRESHAM, OR 970308320 (Tel: 5033102622)

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Organization / Clinic Name Updated August 10, 2017

Operating as WILD EARTH WELLNESS

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Medical Taxonomy / Specialty Registered (Primary Specialty) August 10, 2017

Clinic/Center (License #7615 in OR)

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Initial NPI Registration & Enumeration August 10, 2017

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1285159251
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: August 10, 2017
Last Update: July 21, 2022

Mailing Address

24850 Se Stark St Ste 200

Gresham, OR 970308320

Phone: 5033102622

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.