Healthcare Provider Details

I. General information

NPI: 1417906322
Provider Name (Legal Business Name): THE BABY FOLD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 OGLESBY AVE
NORMAL IL
61761
US

IV. Provider business mailing address

108 E WILLOW ST
NORMAL IL
61761-1640
US

V. Phone/Fax

Practice location:
  • Phone: 309-454-1770
  • Fax: 309-454-9257
Mailing address:
  • Phone: 309-452-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number020329
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. CLETUS WINKELMANN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 309-452-1170