Healthcare Provider Details

I. General information

NPI: 1013841238
Provider Name (Legal Business Name): LOLA'S LIFE CHANGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15507 CICERO AVE
OAK FOREST IL
60452-3629
US

IV. Provider business mailing address

15507 CICERO AVE
OAK FOREST IL
60452-3629
US

V. Phone/Fax

Practice location:
  • Phone: 872-216-3420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRIANA WESCLITZ
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 872-216-3420