Healthcare Provider Details

I. General information

NPI: 1215859459
Provider Name (Legal Business Name): IMPACTFUL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E BENTON ST STE 302
AURORA IL
60505-4200
US

IV. Provider business mailing address

2212 LYNN DR
MONTGOMERY IL
60538-4020
US

V. Phone/Fax

Practice location:
  • Phone: 630-945-0082
  • Fax:
Mailing address:
  • Phone: 630-945-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH JANEL GODINHO
Title or Position: OWNER
Credential: LCSW
Phone: 630-945-0082