Black Willow Holistic Center LLC

Primary specialty

Religious Nonmedical PractitionerTaxonomy code 374K00000X

Legal business name

BLACK WILLOW HOLISTIC CENTER LLC

Practice address

301 Oglesby St
Salem, IL 62881-2724

Phone

(618) 292-8518

NPI assigned

Dec 4, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Candice Ullery, SBDNPI 1386026078

Title

Owner

Phone

(618) 292-8518

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Candice Ullery, SBD

  • Doula
  • Salem, IL
  • NPI 1386026078
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1184490872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 OGLESBY ST",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "628812724",
            "telephone_number": "618-292-8518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 OGLESBY ST",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "628812724",
            "telephone_number": "618-292-8518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK WILLOW HOLISTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-04",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "ULLERY",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-292-8518",
        "authorized_official_credential": "SBD"
    },
    "taxonomies": [
        {
            "code": "374K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Religious Nonmedical Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hope Beckmann
• Behavior Analysis Corporation
• Rachel Benjamin, APRN
• Angela Betters, DNP, APRN, PMHNP
• Erin Elise Bily-Luton
• David R Blair, DDS
• Tiffany Blasa, PT
• Bowman Chiropractic P C
• Michael R Bowman, DC
• Stephanie D Branch, APN

• Religious Nonmedical Practitioner in Salem, IL
• Providers in Salem, IL by specialty
• Religious Nonmedical Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.