Blue Heron Wellness, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

BLUE HERON WELLNESS, LLC

Practice address

515 S Barstow St Ste 117
Eau Claire, WI 54701-2618

Phone

(715) 229-3019

Fax

(715) 229-3268

NPI assigned

May 8, 2024

Organization subpart

No

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

Authorized official

Name

Elizabeth Caroline Davison, LPCNPI 1154894657

Title

Owner/LPC

Phone

(715) 229-3019

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

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

• Elizabeth Davison, MS

  • Professional Counselor
  • Eau Claire, WI
  • NPI 1154894657
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1715126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1437907086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 S BARSTOW ST STE 117",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547012618",
            "telephone_number": "715-229-3019",
            "fax_number": "715-229-3268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 S BARSTOW ST STE 117",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547012618",
            "telephone_number": "715-229-3019",
            "fax_number": "715-229-3268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE HERON WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-08",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "DAVISON",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "CAROLINE",
        "authorized_official_title_or_position": "OWNER/LPC",
        "authorized_official_telephone_number": "715-229-3019",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan M Bledsoe, M.D.
• Taylor Lace Bloczynski, CRNA
• Jessica Bloechl, PHARMD
• Brenna Rae Blomquist, CADC III
• Erica L Bloom, PA-C
• Mindy Blumenberg, LMT
• Kate Elizabeth Bobholz, AU.D.
• Scott Bobholz, M.D.
• Amanda L Bockenfeld, CRNA
• Kendra Kay Boda, D.D.S.,M.S.

• Professional Counselor in Eau Claire, WI
• Providers in Eau Claire, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.