Provider Demographics
NPI:1801460548
Name:DOKKO WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:DOKKO WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:DOKKO
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC
Authorized Official - Phone:773-809-3528
Mailing Address - Street 1:6711 N LORON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-1409
Mailing Address - Country:US
Mailing Address - Phone:303-810-3144
Mailing Address - Fax:
Practice Address - Street 1:17 N WABASH AVE STE 515
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4818
Practice Address - Country:US
Practice Address - Phone:773-809-3528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL181.012798OtherSTATE OF ILLINOIS-DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
1316437809OtherNPPES (NPI 1)