Willow Wellness Center, Pllc | |
1400 Renaissance Dr Ste 401 Park Ridge IL 60068-1337 | |
(847) 318-8200 | |
(847) 318-9170 |
Full Name | Willow Wellness Center, Pllc |
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Speciality | Clinic/Center |
Location | 1400 Renaissance Dr Ste 401, Park Ridge, Illinois |
Authorized Official Name and Position | Lisa Cecilia Campbell (CO-DIRECTOR) |
Authorized Official Contact | 8473188200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Willow Wellness Center, Pllc 1400 Renaissance Dr Ste 401 Park Ridge IL 60068-1337 Ph: (847) 318-8200 | Willow Wellness Center, Pllc 1400 Renaissance Dr Ste 401 Park Ridge IL 60068-1337 Ph: (847) 318-8200 |
NPI Number | 1154437739 |
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Provider Enumeration Date | 08/23/2006 |
Last Update Date | 11/06/2024 |
Certification Date | 11/06/2024 |
Medicare PECOS PAC ID | 0941275267 |
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Medicare Enrollment ID | O20040831000525 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154437739 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
Provider Name | Lisa C Campbell |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1184730764 PECOS PAC ID: 6608779111 Enrollment ID: I20040131000040 |
Provider Name | Mary Morag Sutherland |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1255651162 PECOS PAC ID: 3476708157 Enrollment ID: I20150408001496 |
Provider Name | Caren J Jeskey |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1629401120 PECOS PAC ID: 3476890260 Enrollment ID: I20200729000034 |
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