Healthcare Provider Details

I. General information

NPI: 1003751181
Provider Name (Legal Business Name): SERENA VOLAM LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 FAWELL BLVD
GLEN ELLYN IL
60137-6599
US

IV. Provider business mailing address

4327 STANLEY AVE
DOWNERS GROVE IL
60515-2942
US

V. Phone/Fax

Practice location:
  • Phone: 630-942-2208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.023596
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: