Provider Demographics
NPI:1912423856
Name:MY MINDFUL BIRTH SC
Entity Type:Organization
Organization Name:MY MINDFUL BIRTH SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CERTIFIED NURSE MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLOU
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FPA, CNM
Authorized Official - Phone:630-230-4577
Mailing Address - Street 1:17W681 CONCORD PL
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5124
Mailing Address - Country:US
Mailing Address - Phone:630-230-4577
Mailing Address - Fax:630-383-7224
Practice Address - Street 1:626 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3237
Practice Address - Country:US
Practice Address - Phone:630-230-4577
Practice Address - Fax:630-230-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
IL209-008297367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty