MEDICARE: TANGLED ROOTS, LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1588508592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANGLED ROOTS, LLC

Provider Business Mailing Address
First Line	:	1130 W LAKE COOK RD STE 210
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1975
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 W LAKE COOK RD STE 210
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1975
Country	:	US
Telephone Number	:	224-200-9990
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAILA ZIMMERMAN-MOSCOVITCH
Credential	:	LCSW
Telephone Number	:	224-200-9990

Provider Enumeration Date	:	04/18/2026
Last Update Date	:	04/18/2026

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Directions to “TANGLED ROOTS, LLC ” Practice Location

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