Healthcare Provider Details

I. General information

NPI: 1336095785
Provider Name (Legal Business Name): DEAN WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E 79TH ST
CHICAGO IL
60619-2302
US

IV. Provider business mailing address

132 E 79TH ST
CHICAGO IL
60619-2302
US

V. Phone/Fax

Practice location:
  • Phone: 773-812-9797
  • Fax:
Mailing address:
  • Phone: 773-812-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY DEAN
Title or Position: OWNER
Credential: DNP
Phone: 773-616-9162