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General NPI Number Information
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NPI Number | 1184492530
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Entity Type | Organization
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Legal Business Name | UKWELI HEALING & WELLNESS
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Dates
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Enumeration Date | 12/15/2023
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 1534 W FARGO AVE APT 2S
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City | CHICAGO
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State | IL
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Zip | 60626-1829
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Country | US
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Telephone | 773-641-2584
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE N
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 414-212-5319
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IMANI C WILSON
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Credential | LCSW
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Telephone | 414-212-5319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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