Provider Demographics
NPI:1609682848
Name:GROWING WILD
Entity type:Organization
Organization Name:GROWING WILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TITCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:773-474-9630
Mailing Address - Street 1:194 MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1939
Mailing Address - Country:US
Mailing Address - Phone:207-813-4792
Mailing Address - Fax:
Practice Address - Street 1:194 MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1939
Practice Address - Country:US
Practice Address - Phone:207-813-4792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty