Healthcare Provider Details

I. General information

NPI: 1578748067
Provider Name (Legal Business Name): CHILDRENS WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16505 106TH CT
ORLAND PARK IL
60467-4522
US

IV. Provider business mailing address

16505 106TH CT
ORLAND PARK IL
60467-4522
US

V. Phone/Fax

Practice location:
  • Phone: 708-364-1550
  • Fax: 708-364-1468
Mailing address:
  • Phone: 708-364-1550
  • Fax: 708-364-1468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KENYA WILBANKS
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-364-1550