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General NPI Number Information
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NPI Number | 1053271908
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Entity Type | Organization
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Legal Business Name | ROOTED MENTAL HEALTH SERVICES PLLC
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 412 S 2ND ST
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City | ST CHARLES
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State | IL
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Zip | 60174-2819
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Country | US
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Telephone | 630-381-5595
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Fax | 331-336-5640
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Provider Business Mailing Address
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Address Line | 409 TWINLEAF TRL
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City | YORKVILLE
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State | IL
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Zip | 60560-4690
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Country | US
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Telephone | 708-222-7325
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Fax | 331-336-5640
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Authorized Official
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Title or Position | PMHNP
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Name | AMANDA LAWAL
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Credential | APRN
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Telephone | 708-222-7325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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