Wild Fern Clinical Therapy PLLC
NPI 1346084829ActiveOrganization· Social Worker, Clinical· Berwyn, IL
Social Worker, Clinical in Berwyn, Illinois, registered in NPPES in June 2024. The authorized official on file is Elise Johnston Dumerauf, LCSW, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1346084829 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 20, 2024 |
| Last updated in NPPES | Aug 25, 2024 |
| Certified by provider | Aug 25, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IL) |
|---|
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