Engram Therapy And Wellness Clinic

LBN: Engram
Engram Therapy And Wellness Clinic is an health care organization with primary practice located at 2655 W Peterson Ave , Chicago IL 60659-4017. The organization recently has 3 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist is the primary health care specialty. Engram can be contacted via phone (630) 729-4344, or through Haverland, Carla Mae R via phone (630) 729-4344.

Contact Information

Primary practice address
2655 W Peterson Ave Chicago IL 60659-4017
Phone: (630) 729-4344
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Haverland, Carla Mae R PT, GCS
Phone: (630) 729-4344

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X

Profile Details

NPI number 1295404820
LBN Legal business name Engram
DBA Doing business as Engram Therapy And Wellness Clinic
Authorized official Haverland, Carla Mae R PT, GCS
Entity Organization
Organization subpart 1 Yes
Enumeration date Sep 8th, 2021
Last updated Apr 1st, 2022 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295404820 NPPES
Illinois MEDICAID 1184899072

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