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NPI Code Detail

MEDICARE: ROOTS OF RESILIENCE PLLC

MEDICARE: ROOTS OF RESILIENCE PLLC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1942956289
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROOTS OF RESILIENCE PLLC
Provider Business Mailing Address
First Line : 11745 SOUTHWEST HWY
Second Line :
City : PALOS HEIGHTS
State : IL
Zip : 60463-1038
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11745 SOUTHWEST HWY
Second Line :
City : PALOS HEIGHTS
State : IL
Zip : 60463-1038
Country : US
Telephone Number : 708-710-3190
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CAITLIN KNIGHT
Credential : LCPC
Telephone Number : 708-480-9945
Provider Enumeration Date : 02/24/2022
Last Update Date : 08/21/2022

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Directions to “ROOTS OF RESILIENCE PLLC ” Practice Location

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