MEDICARE: SYSTEMIC WELLNESS, P.C.

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1518697788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYSTEMIC WELLNESS, P.C.

Provider Business Mailing Address
First Line	:	2081 CALISTOGA DR STE 2N
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-4833
Country	:	US
Telephone Number	:	815-320-2410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2081 CALISTOGA DR STE 2N
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-4833
Country	:	US
Telephone Number	:	815-320-2410
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAITLIN D SUERTH
Credential	:	LCPC
Telephone Number	:	708-590-9870

Provider Enumeration Date	:	06/12/2022
Last Update Date	:	06/26/2026

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