Healthcare Provider Details
I. General information
NPI: 1003585126
Provider Name (Legal Business Name): MOTHERGOOD HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/11/2021
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
33 W HIGGINS RD STE 950
SOUTH BARRINGTON IL
60010-9140
US
IV. Provider business mailing address
33 W HIGGINS RD STE 950
SOUTH BARRINGTON IL
60010-9140
US
V. Phone/Fax
- Phone: 847-986-8010
- Fax: 847-986-8106
- Phone: 847-986-8010
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TH0004X |
| Taxonomy | Health Psychologist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MATTHEW
JOHN
MCCUE
Title or Position: CO-FOUNDER
Credential:
Phone: 312-315-8983