Healthcare Provider Details

I. General information

NPI: 1053271908
Provider Name (Legal Business Name): ROOTED MENTAL HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 S 2ND ST
ST CHARLES IL
60174-2819
US

IV. Provider business mailing address

409 TWINLEAF TRL
YORKVILLE IL
60560-4690
US

V. Phone/Fax

Practice location:
  • Phone: 630-381-5595
  • Fax: 331-336-5640
Mailing address:
  • Phone: 708-222-7325
  • Fax: 331-336-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LAWAL
Title or Position: PMHNP
Credential: APRN
Phone: 708-222-7325