Organization
BOOM WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIKA WALTON LCSW (OWNER)
(312) 574-0025
Entity
Organization
Contact information
Practice address
4328 S FAIRFIELD AVE, CHICAGO, IL 60632-1223
(219) 617-9162
Mailing address
4328 S FAIRFIELD AVE, CHICAGO, IL 60632-1223
(219) 617-9162
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/29/2024
Last updated
01/29/2024
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