| Watershed Wellness Llc | |
|
579 N 1st Bank Dr Ste 150 Palatine IL 60067-8102 | |
| (737) 831-5700 | |
| (847) 907-9994 |
| Full Name | Watershed Wellness Llc |
|---|---|
| Speciality | Psychologist |
| Location | 579 N 1st Bank Dr Ste 150, Palatine, Illinois |
| Authorized Official Name and Position | Ashton Marie Lofgreen (CLINICAL PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 7738315700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Watershed Wellness Llc 579 N 1st Bank Dr Ste 150 Palatine IL 60067-8102 Ph: (737) 831-5700 | Watershed Wellness Llc 579 N 1st Bank Dr Ste 150 Palatine IL 60067-8102 Ph: (737) 831-5700 |
| NPI Number | 1316429814 |
|---|---|
| Provider Enumeration Date | 08/30/2018 |
| Last Update Date | 12/13/2021 |
| Certification Date | 12/13/2021 |
| Medicare PECOS PAC ID | 8527474964 |
|---|---|
| Medicare Enrollment ID | O20210309001643 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316429814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071009227 (Illinois) | Primary |
| Provider Name | Ashton M. Lofgreen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689027104 PECOS PAC ID: 1951681774 Enrollment ID: I20161213000250 |
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