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General NPI Number Information
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NPI Number | 1225892748
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Entity Type | Organization
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Legal Business Name | PER LA VITA WELLNESS PLLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 3380 LACROSSE LN STE 111
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City | NAPERVILLE
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State | IL
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Zip | 60564-8521
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Country | US
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Telephone | 630-474-5119
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Fax |
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Provider Business Mailing Address
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Address Line | 3380 LACROSSE LN STE 111
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City | NAPERVILLE
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State | IL
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Zip | 60564-8521
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Country | US
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Telephone | 630-383-1102
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DR. KRISTEN BRENDEL
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Credential | PHD, LCSW
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Telephone | 630-383-1102
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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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