# WILDFLOWER THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275373391
- **Authorized official:** MRS. JACQUELINE SHEA GOODALL LICSW (OWNER/CLINICIAN)
- **Authorized official phone:** (978) 831-3196

## Contact information

- **Practice address:** 57 S MAIN ST, WATERBURY, VT 05676-1557
- **Practice address phone:** (978) 831-3196
- **Mailing address:** 67 FAIRGROUND RD, WATERBURY, VT 05676-8903
- **Mailing address phone:** (978) 831-3196

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 05/28/2024
- **Last updated:** 06/24/2024