Provider Demographics
NPI:1558847335
Name:INNER BALANCE WELLNESS
Entity Type:Organization
Organization Name:INNER BALANCE WELLNESS
Other - Org Name:INNER BALANCE WELLNESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPADIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:331-481-6562
Mailing Address - Street 1:233 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2655
Mailing Address - Country:US
Mailing Address - Phone:630-441-2241
Mailing Address - Fax:
Practice Address - Street 1:303 E ARMY TRAIL RD STE 207
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2143
Practice Address - Country:US
Practice Address - Phone:332-481-6563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty