Healthcare Provider Details

I. General information

NPI: 1912423856
Provider Name (Legal Business Name): MY MINDFUL BIRTH SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 E OGDEN AVE
NAPERVILLE IL
60563-3237
US

IV. Provider business mailing address

17W681 CONCORD PL
DARIEN IL
60561-5124
US

V. Phone/Fax

Practice location:
  • Phone: 630-230-4577
  • Fax: 630-230-4552
Mailing address:
  • Phone: 630-230-4577
  • Fax: 630-383-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209-008297
License Number StateIL

VIII. Authorized Official

Name: ISABELLE GUILLOU
Title or Position: OWNER, CERTIFIED NURSE MIDWIFE
Credential: APRN-FPA, CNM
Phone: 630-230-4577