Healthcare Provider Details

I. General information

NPI: 1336050087
Provider Name (Legal Business Name): DEEP WATERS THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2926 BEEMERVILLE RD
COMPTON IL
61318
US

IV. Provider business mailing address

PO BOX 9001
NAPERVILLE IL
60567-0001
US

V. Phone/Fax

Practice location:
  • Phone: 331-481-9007
  • Fax:
Mailing address:
  • Phone: 331-481-9007
  • 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: JESSICA MEISINGER
Title or Position: OWNER
Credential: LCSW
Phone: 331-481-9007