Healthcare Provider Details

I. General information

NPI: 1437885720
Provider Name (Legal Business Name): THE MENDING ROOM COUNSELING CENTER FOR WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16649 OAK PARK AVE
TINLEY PARK IL
60477-1842
US

IV. Provider business mailing address

16649 OAK PARK AVE STE H
TINLEY PARK IL
60477-1843
US

V. Phone/Fax

Practice location:
  • Phone: 954-887-9807
  • Fax: 754-732-7441
Mailing address:
  • Phone: 954-887-9807
  • Fax: 754-732-7441

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: MRS. JESSICA OLADUMIYE
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LCSW
Phone: 954-787-8702