NPIMap

Organization Active NPI

Center for Personal Wellness, LLC

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1669922894
Registry record updated Oct 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180008510 Issued in IL
Legal business name
CENTER FOR PERSONAL WELLNESS, LLC
Practice address
1658 N Milwaukee Ave
#100-6986
Chicago, IL 60647-6905
Phone
(419) 628-0124
Fax
(419) 469-5553
NPI assigned
Oct 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2016

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

Authorized official

Name
Laura RoetgermanNPI 1437588894
Title
Owner
Phone
(419) 628-0124

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X 180008510 IL Primary

Addresses

Primary practice location

1658 N Milwaukee Ave
#100-6986
Chicago, IL 60647-6905

Mailing address

96 W 4TH St
Minster, OH 45865-1090
Phone (419) 628-0124

National Provider Directory

National Provider Directory
Tax ID family
Center for Personal Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476230400000",
    "number": "1669922894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 W 4TH ST",
            "city": "MINSTER",
            "state": "OH",
            "postal_code": "458651090",
            "telephone_number": "419-628-0124",
            "fax_number": "419-469-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1658 N MILWAUKEE AVE",
            "address_2": "#100-6986",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606476905",
            "telephone_number": "419-628-0124",
            "fax_number": "419-469-5553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR PERSONAL WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-10-12",
        "status": "A",
        "authorized_official_last_name": "ROETGERMAN",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-628-0124"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180008510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; 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.