NPI 1184490872

Black Willow Holistic Center LLC

Organisation Religious Nonmedical Practitioner Salem, IL

Practice location

Address: 301 Oglesby St, Salem, IL 62881-2724
Phone: (618) 292-8518

Authorised official

Name: Candice Ullery
Title: Owner
Phone: (618) 292-8518

Registered specialties

Religious Nonmedical Practitioner Primary

Nursing Service Related Providers Taxonomy 374K00000X

Other Religious Nonmedical Practitioner providers in Illinois →

Registry record

NPI: 1184490872
Entity type: Organization
NPI issued: 4 Dec 2023
Record last updated: 12 Dec 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.