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Organization
RIDE THE WAVE WELLNESS, INC.
Active
Organization
RIDE THE WAVE WELLNESS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE K KNEPPER LCPC (OWNER/CLINICAL PSYCHOTHERAPIST)
(630) 383-7006
Entity
Organization
Contact information
Practice address
123 W WASHINGTON ST STE 340, OSWEGO, IL 60543-8292
(630) 383-7006
(630) 383-7006
Mailing address
2405 TWIN FOUNTAIN CT, PLAINFIELD, IL 60586-6397
(773) 655-1198
(630) 383-7006
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
180.0004778
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194092635
NPI 1
IL
Enumeration date
07/08/2017
Last updated
07/08/2017
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