Well-Rooted Functional Medicine

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

WELL-ROOTED FUNCTIONAL MEDICINE

Practice address

110 S Johnson St Ste 207
Woodstock, IL 60098-3259

Phone

(815) 355-1605

NPI assigned

Mar 2, 2021

Organization subpart

No

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

Authorized official

Name

Jessica Pawlicki, NPNPI 1972909877

Title

Owner

Phone

(815) 529-1201

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

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

• Jessica Pawlicki

  • Nurse Practitioner
  • Crystal Lake, IL
  • NPI 1972909877
  NPD Authorized official

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

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1205421237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S JOHNSON ST STE 207",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600983259",
            "telephone_number": "815-355-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S JOHNSON ST STE 207",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600983259",
            "telephone_number": "815-355-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELL-ROOTED FUNCTIONAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-02",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "PAWLICKI",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-529-1201",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "practicefusion.com",
            "affiliation": "N",
            "address_1": "110 S Johnson St Ste 207",
            "city": "Woodstock",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600983259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David Washington, MSW
• Lisa Jean Washkowiak, M.A., CCC-SLP/L
• Holly Noel Watson-Evans, MS, FNP-BC
• Christine R Watson, PA-C
• Barbara Webb, LCSW
• Barbara Wetzstein
• Whitney Behm DMD, LLC
• Alyssa Beth Wienke, OTR/L
• Lisa Ann Winkelhake, CNA
• Kelly Marie Winkelman, APRN, ANP-BC

• Medical Specialty Clinic/Center in Woodstock, IL
• Providers in Woodstock, IL by specialty
• Medical Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.