Provider Demographics
NPI:1477892446
Name:DOMINICAN UNIVERSITY WELLNESS CENTER
Entity Type:Organization
Organization Name:DOMINICAN UNIVERSITY WELLNESS CENTER
Other - Org Name:WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RITZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-524-6229
Mailing Address - Street 1:7900 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1066
Mailing Address - Country:US
Mailing Address - Phone:708-524-6229
Mailing Address - Fax:708-488-5072
Practice Address - Street 1:7900 DIVISION ST
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1066
Practice Address - Country:US
Practice Address - Phone:708-524-6229
Practice Address - Fax:708-488-5072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOMINICAN UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-250937261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health