Healthcare Provider Details

I. General information

NPI: 1801571229
Provider Name (Legal Business Name): HEARTLAND WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18036 GOTTSCHALK AVE
HOMEWOOD IL
60430-1712
US

IV. Provider business mailing address

304 QUEENS LN
THORNTON IL
60476-1080
US

V. Phone/Fax

Practice location:
  • Phone: 708-491-2655
  • Fax:
Mailing address:
  • Phone: 708-564-5071
  • Fax: 708-564-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TALETHA K BROWN
Title or Position: APN
Credential: APN
Phone: 708-491-2655