MEDICARE: MOON CYCLE MAMA DOULA AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1497617484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOON CYCLE MAMA DOULA AND WELLNESS

Provider Business Mailing Address
First Line	:	1 E ERIE ST STE 525
Second Line	:	# 4099
City	:	CHICAGO
State	:	IL
Zip	:	60611
Country	:	US
Telephone Number	:	773-234-2260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-4095
Country	:	US
Telephone Number	:	773-234-2260
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	KERRI HONEYWOOD
Credential	:
Telephone Number	:	773-642-4707

Provider Enumeration Date	:	11/27/2025
Last Update Date	:	12/09/2025

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