Healthcare Provider Details

I. General information

NPI: 1639096985
Provider Name (Legal Business Name): WILDROOT RELATIONSHIP THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 THUNDER GULCH RD
MONTGOMERY IL
60538-3442
US

IV. Provider business mailing address

2335 THUNDER GULCH RD
MONTGOMERY IL
60538-3442
US

V. Phone/Fax

Practice location:
  • Phone: 630-618-2208
  • Fax: 331-226-0421
Mailing address:
  • Phone: 630-618-2208
  • Fax: 331-226-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN JOY TUNE
Title or Position: OWNER
Credential: LMFT
Phone: 630-379-9743