Healthcare Provider Details

I. General information

NPI: 1740725217
Provider Name (Legal Business Name): WISDOM FOR THE JOURNEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N HARLEM AVE STE 205-5
OAK PARK IL
60302-1205
US

IV. Provider business mailing address

1416 S 11TH AVE
MAYWOOD IL
60153-1962
US

V. Phone/Fax

Practice location:
  • Phone: 708-405-9648
  • Fax:
Mailing address:
  • Phone: 708-356-6754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0587013-5
License Number StateIL

VIII. Authorized Official

Name: MS. KELLEE WATKINS
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 708-356-6754