Provider Demographics
NPI:1619782604
Name:VIBEWELL CHICAGO PLLC
Entity type:Organization
Organization Name:VIBEWELL CHICAGO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGOVIA-RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-312-8939
Mailing Address - Street 1:687 E CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-5762
Mailing Address - Country:US
Mailing Address - Phone:312-312-8939
Mailing Address - Fax:
Practice Address - Street 1:687 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-5762
Practice Address - Country:US
Practice Address - Phone:312-312-8939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty