Healthcare Provider Details

I. General information

NPI: 1336076546
Provider Name (Legal Business Name): PROFOUND BIRTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CHICAGO RD FL 1
OSWEGO IL
60543-9461
US

IV. Provider business mailing address

405 FRANKFORT AVE
OSWEGO IL
60543-7756
US

V. Phone/Fax

Practice location:
  • Phone: 630-724-5620
  • Fax:
Mailing address:
  • Phone: 630-724-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: RAYA WILLIAMS
Title or Position: OWNER
Credential: LCPM, CPM, LM
Phone: 312-656-1109