Wicked Wellness Spa PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WICKED WELLNESS SPA PLLC

Practice address

6700 167TH St Ste 4&5
Tinley Park, IL 60477-2859

Phone

(708) 781-3007

Fax

(708) 600-2005

NPI assigned

Apr 5, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Phylia Irene Bolls, NPNPI 1750011748

Title

Owner

Phone

(708) 600-2005

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Phylia Irene Bolls

  • Emergency Registered Nurse
  • Tinley Park, IL
  • NPI 1750011748

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743811200000",
    "number": "1104610286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 167TH ST STE 4&5",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772859",
            "telephone_number": "708-781-3007",
            "fax_number": "708-600-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 167TH ST STE 4&5",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772859",
            "telephone_number": "708-781-3007",
            "fax_number": "708-600-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKED WELLNESS SPA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-05",
        "last_updated": "2025-04-05",
        "certification_date": "2025-04-05",
        "status": "A",
        "authorized_official_last_name": "BOLLS",
        "authorized_official_first_name": "PHYLIA",
        "authorized_official_middle_name": "IRENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-600-2005",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Weil Foot and Ankle Institute LLC
• Wellness Society LLC
• Diane Wendt, LCPC
• Ashley White
• Jo'Landa White
• Virginia Widdows, RBT
• Leah Wideman
• Brandon R Wigboldy, MS CCC-SLP/L
• Deborah Wilkerson, L.P.C.
• Karen F Will, DO

• Family Medicine Physician in Tinley Park, IL
• Providers in Tinley Park, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.