Root & Vines Wellness, PLLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Chicago, IL. Organization (NPI-2).
NPI number1013774587
StatusActive
Last updated in NPPESMar 1, 2024
Details
- NPI
- 1013774587
- Entity type
- Organization (NPI-2)
- Legal business name
- Root & Vines Wellness, PLLC
- Organization subpart
- No
- Enumeration date
- Mar 1, 2024
- Certification date
- Mar 1, 2024
- Last updated
- Mar 1, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
2919 N Racine Ave BsmtChicago, IL 60657-4223
Phone 505-331-3467
Mailing address
2919 N Racine Ave BsmtChicago, IL 60657-4223
Phone 505-331-3467
Authorized official
Ivy F Malisow
Therapist
5053313467
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