WELL-ROOTED FUNCTIONAL MEDICINE NPI 1205421237

NPI Information

  • NPI: 1205421237
  • Provider Name: WELL-ROOTED FUNCTIONAL MEDICINE
  • Classification: Clinic/Center - 261QM2500X
  • Specialization: Medical Specialty
  • Entity Type: Organization
  • Address: 110 S JOHNSON ST STE 207
    WOODSTOCK, IL
    ZIP 60098
  • Phone: (815) 355-1605

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NPI Details

WELL-ROOTED FUNCTIONAL MEDICINE is a medical specialty clinic center in Woodstock, IL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). WELL-ROOTED FUNCTIONAL MEDICINE NPI is 1205421237. The provider is registered as an organization entity type.

The provider's business location address is:

110 S JOHNSON ST STE 207
WOODSTOCK, IL
ZIP 60098-259
Phone: (815) 355-1605

The provider's authorized official is Jessica Pawlicki .
The authorized official title is Owner and has the following contact phone number (815) 529-1201.

The enumeration date for this NPI number is 3/2/2021 and was last updated on 3/2/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM2500XClinic/CenterMedical SpecialtyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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