# LYMPHATIC WELLNESS CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134719479
- **Authorized official:** SANDRA WALLIN OT (MANAGING MEMBER/OWNER)
- **Authorized official phone:** (708) 328-8594

## Contact information

- **Practice address:** 120 S MADISON AVE, LA GRANGE, IL 60525-2340
- **Practice address phone:** (708) 328-8594
- **Mailing address:** 120 S MADISON AVE, LA GRANGE, IL 60525-2340

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |

## Other

- **Enumeration date:** 01/20/2021
- **Last updated:** 01/24/2022