Healthcare Provider Details

I. General information

NPI: 1518697788
Provider Name (Legal Business Name): SYSTEMIC WELLNESS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 CALISTOGA DR STE 2N
NEW LENOX IL
60451-4833
US

IV. Provider business mailing address

2081 CALISTOGA DR STE 2N
NEW LENOX IL
60451-4833
US

V. Phone/Fax

Practice location:
  • Phone: 815-320-2410
  • Fax:
Mailing address:
  • Phone: 815-320-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAITLIN D SUERTH
Title or Position: OWNER
Credential: LCPC
Phone: 708-590-9870