Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Wild Roots Therapeutics

Organization Clinical Social Worker · NPI 1922853779

Wild Roots Therapeutics is a Clinical Social Worker in Salida, Colorado. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

134 F St Ste 201
Salida, CO 81201-2160
Phone: (720) 443-4933
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1922853779
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mamie Tisue — Owner, Clinician · (719) 752-5672
NPI enumeratedApril 23, 2024
Last updated in NPPESAugust 6, 2026
Certification dateAugust 6, 2026
Mailing address134 F St Ste 201, Salida, CO 81201-2160

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