Provider Demographics
NPI:1316017635
Name:WELLNESS CLINIC LTD
Entity Type:Organization
Organization Name:WELLNESS CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-886-5770
Mailing Address - Street 1:3510 HOBSON RD STE 302
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1442
Mailing Address - Country:US
Mailing Address - Phone:630-886-5770
Mailing Address - Fax:866-415-1201
Practice Address - Street 1:3510 HOBSON RD STE 302
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1442
Practice Address - Country:US
Practice Address - Phone:630-886-5770
Practice Address - Fax:866-415-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0426181022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095935OtherILLINOIS STATE LICENSE