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Organization

CHILDRENS WELLNESS CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. DONNA VELAZQUEZ (OFFICE MANAGER)
(708) 636-8747
Entity
Organization

Contact information

Practice address
16505 106TH CT, ORLAND PARK, IL 60467-4545
(708) 364-1550
(708) 364-1468
Mailing address
9830 RIDGELAND AVE, CHICAGO RIDGE, IL 60415-2667
(708) 636-8747
(708) 636-5854

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036079532
IL
174400000X
Specialist
036114693
IL
174400000X
Specialist
036115658
IL
174400000X
Specialist
036116141
IL
363LP0200X
Pediatric Nurse Practitioner
209010813
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1235263955
NPI
IL
01
1376971911
NPI
IL
01
1669506390
NPI
IL
01
1871714360
NPI
IL
01
1912930348
NPI
IL
Enumeration date
01/03/2008
Last updated
12/02/2013
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