| Enriching Wellness Llc | |
|
2225 Gateway Dr Sycamore IL 60178-3139 | |
| (815) 501-4857 | |
| Not Available |
| Full Name | Enriching Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2225 Gateway Dr, Sycamore, Illinois |
| Authorized Official Name and Position | Jill Davis-kuzmanich (OWNER/LCSW) |
| Authorized Official Contact | 8155014857 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Enriching Wellness Llc 107 Forsythe Ln Dekalb IL 60115-2337 Ph: (815) 501-4857 | Enriching Wellness Llc 2225 Gateway Dr Sycamore IL 60178-3139 Ph: (815) 501-4857 |
| NPI Number | 1134741358 |
|---|---|
| Provider Enumeration Date | 05/11/2020 |
| Last Update Date | 05/11/2020 |
| Certification Date | 05/11/2020 |
| Medicare PECOS PAC ID | 5092134411 |
|---|---|
| Medicare Enrollment ID | O20201002002098 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134741358 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jill Davis-kuzmanich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679009435 PECOS PAC ID: 2466882006 Enrollment ID: I20200422000314 |
| Provider Name | Dahlia L Roman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194220343 PECOS PAC ID: 9335525591 Enrollment ID: I20220926003607 |
| Provider Name | Kristina Lee Frank |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801566286 PECOS PAC ID: 8325413800 Enrollment ID: I20230414001640 |
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