# WELL-ROOTED FUNCTIONAL MEDICINE

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

## Provider details

- **NPI number:** 1205421237
- **Authorized official:** JESSICA PAWLICKI NP (OWNER)
- **Authorized official phone:** (815) 529-1201

## Contact information

- **Practice address:** 110 S JOHNSON ST STE 207, WOODSTOCK, IL 60098-3259
- **Practice address phone:** (815) 355-1605
- **Mailing address:** 110 S JOHNSON ST STE 207, WOODSTOCK, IL 60098-3259
- **Mailing address phone:** (815) 355-1605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/02/2021
- **Last updated:** 03/02/2021