Provider Demographics
NPI:1780739839
Name:WELLS AND ASSOCIATES WELLNESS CENTER
Entity type:Organization
Organization Name:WELLS AND ASSOCIATES WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, LMT, CLT
Authorized Official - Phone:815-895-1044
Mailing Address - Street 1:407 W STATE ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-1455
Mailing Address - Country:US
Mailing Address - Phone:815-895-1044
Mailing Address - Fax:815-895-1054
Practice Address - Street 1:407 W STATE ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1455
Practice Address - Country:US
Practice Address - Phone:815-895-1044
Practice Address - Fax:815-895-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X, 163WM1400X, 163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Multi-Specialty