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General NPI Number Information
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NPI Number | 1497255517
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Entity Type | Organization
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Legal Business Name | DANDELION WELLNESS, LLC
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Dates
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Enumeration Date | 02/15/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 307 N MICHIGAN AVE STE 412
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City | CHICAGO
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State | IL
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Zip | 60601-5318
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Country | US
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Telephone | 312-909-5329
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Fax |
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Provider Business Mailing Address
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Address Line | 6133 N CHRISTIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60659-2311
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Country | US
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Telephone | 312-909-5329
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | KAREN E FAYDEN
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Credential | LCSW
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Telephone | 312-909-5329
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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 | 149015168
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License Number State | IL
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