Healthcare Provider Details

I. General information

NPI: 1780739839
Provider Name (Legal Business Name): WELLS AND ASSOCIATES WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W STATE ST SUITE 1A
SYCAMORE IL
60178-1455
US

IV. Provider business mailing address

407 W STATE ST SUITE 1A
SYCAMORE IL
60178-1455
US

V. Phone/Fax

Practice location:
  • Phone: 815-895-1044
  • Fax: 815-895-1054
Mailing address:
  • Phone: 815-895-1044
  • Fax: 815-895-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number
License Number StateIL

VIII. Authorized Official

Name: MARY B. WELLS
Title or Position: OWNER
Credential: RN, MSN, LMT, CLT
Phone: 815-895-1044