Healthcare Provider Details

I. General information

NPI: 1922921808
Provider Name (Legal Business Name): ROOTED MIND & BODY WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 MAIN ST STE 302-C
OSWEGO IL
60543-1264
US

IV. Provider business mailing address

110 DORSET AVE
OSWEGO IL
60543-6054
US

V. Phone/Fax

Practice location:
  • Phone: 847-452-6025
  • Fax:
Mailing address:
  • Phone: 847-452-6025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LAMORTE
Title or Position: OWNER
Credential: LCSW, CYT-200
Phone: 847-452-6025