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WICKED WELLNESS SPA PLLC
NPI 1104610286
Family Medicine in Tinley Park, IL

Active since April 05, 2025CLIA 14D2338844 · Waiver
6700 167TH ST STE 4&5, TINLEY PARK, IL 60477(708) 781-3007(708) 600-2005 Get Directions Write a Review

NPPES record last updated: April 5, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Wicked Wellness Spa Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WICKED WELLNESS SPA PLLC (NPI 1104610286) is a healthcare organization registered as a family medicine in Tinley Park, Illinois and active in the NPI registry since April 2025. The organization holds a CLIA Waiver certificate valid through February 18, 2028 and lists Phylia Irene Bolls, Owner, as its authorized official.

NPPES Registry Identity

NPI1104610286
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameWICKED WELLNESS SPA PLLC
Location Address6700 167TH ST STE 4&5Tinley Park, IL 60477-2859
Mailing Address6700 167th St Ste 4&5Tinley Park, IL 60477-2859 · (708) 781-3007 · Fax (708) 600-2005
Phone(708) 781-3007
Fax(708) 600-2005
Organization SubpartNo
Authorized OfficialPhylia Irene BollsOwner · (708) 600-2005
Enumeration DateApril 5, 2025
NPPES CertifiedApril 5, 2025
✔ NPI 1104610286 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
6700 167TH ST STE 4&5, Tinley Park, IL 60477
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2338844

Wicked Wellness Spa PLLC · Tinley Park, IL
Active · expires Feb 18, 2028
CLIA Number14D2338844
Laboratory TypePractitioner Other
Certificate Effective DateFebruary 19, 2026
Certificate Expiration DateFebruary 18, 2028
Laboratory DirectorPhylia I. Bolls
Laboratory Phone(708) 781-3007
Laboratory LocationWicked Wellness Spa PLLC6700 167th St - Ste 5, Tinley Park, IL 60477
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wicked Wellness Spa PLLC's NPI number?

The NPI number for Wicked Wellness Spa PLLC is 1104610286. It was assigned to this organization in the NPPES registry on April 5, 2025.

Where is Wicked Wellness Spa PLLC located?

Wicked Wellness Spa PLLC is located at 6700 167th St Ste 4&5, Tinley Park, IL 60477. The listed phone number is (708) 781-3007.

What is Wicked Wellness Spa PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Wicked Wellness Spa PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2338844) is associated with this NPI, valid through February 18, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Wicked Wellness Spa PLLC was last updated on April 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.