MEDICARE: BIRCH RIVER WELLNESS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149009754	IL

General Provider Information

NPI Number	:	1669843561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRCH RIVER WELLNESS, P.C.

Provider Business Mailing Address
First Line	:	4525 N. RAVENSWOOD AVE
Second Line	:	SUITE 201
City	:	CHICAGO
State	:	IL
Zip	:	60640-8038
Country	:	US
Telephone Number	:	312-203-3405
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 N. RAVENSWOOD AVE
Second Line	:	SUITE 201
City	:	CHICAGO
State	:	IL
Zip	:	60640-8038
Country	:	US
Telephone Number	:	312-203-3405
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. PAMELA JEAN BELL
Credential	:	LCSW
Telephone Number	:	312-203-3405

Provider Enumeration Date	:	10/18/2015
Last Update Date	:	08/15/2025

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