{"npi":"1780107706","type":"NPI-2","status":"active","name":{"display":"Willow Of Wonder Child & Family Therapy PLLC","other":[],"organization_name":"WILLOW OF WONDER CHILD & FAMILY THERAPY PLLC","authorised_official":"Rebecca Konarz"},"specialty":{"primary_taxonomy":"1041C0700X","primary_taxonomy_description":"Clinical Social Worker","slug":"clinical-social-worker","schema_org_specialty":null,"all":[{"code":"1041C0700X","description":"Clinical Social Worker","primary":true,"state":"MI","license":"6801083801"}]},"addresses":[{"purpose":"LOCATION","street_1":"35218 23 MILE RD","city":"NEW BALTIMORE","state":"MI","postal_code":"480473650","country_code":"US","phone":"5862911899"},{"purpose":"MAILING","street_1":"35587 BROOKE CT","city":"NEW BALTIMORE","state":"MI","postal_code":"480471137","country_code":"US","phone":"5862911899","fax":"5862730107"}],"license":{"state":"MI","number":"6801083801"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"CVO138370","state":"MI","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20180319001597","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"MI","pac_id":"2860754439"}]},"enumeration_date":"2017-07-21","last_updated":"2024-04-22","_meta":{"source":"NPPES","snapshot_date":"2024-04-22","doc_url":"https://findmynpi.com/api"}}