MEDICARE: REIMAGINE WELLBEING, LLC

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

General Provider Information

NPI Number	:	1881412591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REIMAGINE WELLBEING, LLC

Provider Business Mailing Address
First Line	:	3211 W LE MOYNE ST APT 3C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-2681
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3211 W LE MOYNE ST APT 3C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-2681
Country	:	US
Telephone Number	:	847-502-4983
Fax Number	:

Authorized Official
Title or Position	:	OWNER, THERAPIST
Name	:	JORDAN CHAPLIK
Credential	:	LCSW
Telephone Number	:	847-502-4983

Provider Enumeration Date	:	10/01/2024
Last Update Date	:	10/01/2024

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