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General NPI Number Information
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NPI Number | 1669137774
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Entity Type | Organization
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Legal Business Name | BEND HEALTH PSYCHIATRIC SERVICES SOUTH PC
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 821 E WASHINGTON AVE FL 2
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City | MADISON
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State | WI
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Zip | 53703-4647
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Country | US
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Telephone | 800-516-0975
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Fax |
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Provider Business Mailing Address
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Address Line | 2640 WHITE OAK CIR STE C
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City | AURORA
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State | IL
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Zip | 60502-4809
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Country | US
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Telephone | 800-516-0975
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MONIKA DRUMMOND ROOTS
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Credential | MD
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Telephone | 612-250-9737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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