Provider Demographics
NPI:1912373069
Name:OSWEGO WELLNESS, INC
Entity Type:Organization
Organization Name:OSWEGO WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-519-1010
Mailing Address - Street 1:64 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9893
Mailing Address - Country:US
Mailing Address - Phone:630-519-1010
Mailing Address - Fax:630-405-7209
Practice Address - Street 1:64 MAIN ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9893
Practice Address - Country:US
Practice Address - Phone:630-519-1010
Practice Address - Fax:630-405-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health