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NPI Code Detail

MEDICARE: SG WELLNESS LLC

MEDICARE: SG WELLNESS 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1952887812
Entity Type Code : Organization
Provider Name (Legal Business Name) : SG WELLNESS LLC
Provider Business Mailing Address
First Line : 1603 ORRINGTON AVE STE 600
Second Line :
City : EVANSTON
State : IL
Zip : 60201-3860
Country : US
Telephone Number : 847-861-7899
Fax Number :
Provider Business Practice Location Address
First Line : 1603 ORRINGTON AVE STE 600
Second Line :
City : EVANSTON
State : IL
Zip : 60201-3860
Country : US
Telephone Number : 847-861-7899
Fax Number :
Authorized Official
Title or Position : LCSW
Name : THERESE GIVEN
Credential :
Telephone Number : 847-861-7899
Provider Enumeration Date : 07/13/2018
Last Update Date : 08/10/2022

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Directions to “SG WELLNESS LLC ” Practice Location

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