Provider Demographics
NPI:1225929896
Name:LAVENDER & IVY WELLNESS LLC
Entity type:Organization
Organization Name:LAVENDER & IVY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:APSW
Authorized Official - Phone:651-302-3496
Mailing Address - Street 1:1630 FORDEM AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-7137
Mailing Address - Country:US
Mailing Address - Phone:651-302-3496
Mailing Address - Fax:
Practice Address - Street 1:121 E MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3351
Practice Address - Country:US
Practice Address - Phone:608-389-0148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty