| Willow Wellness Center, Llc | |
|
1400 Renaissance Dr Ste 401 Park Ridge IL 60068-1337 | |
| (847) 318-8200 | |
| (847) 318-9170 |
| Full Name | Willow Wellness Center, Llc |
|---|---|
| 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 |
|---|---|
| Willow Wellness Center, Llc 1400 Renaissance Dr Ste 401 Park Ridge IL 60068-1337 Ph: (847) 318-8200 | Willow Wellness Center, Llc 1400 Renaissance Dr Ste 401 Park Ridge IL 60068-1337 Ph: (847) 318-8200 |
| NPI Number | 1154437739 |
|---|---|
| Provider Enumeration Date | 08/23/2006 |
| Last Update Date | 01/26/2023 |
| Certification Date | 01/26/2023 |
| Medicare PECOS PAC ID | 0941275267 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184730764 PECOS PAC ID: 6608779111 Enrollment ID: I20040131000040 |
| Provider Name | Mary Morag Sutherland |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255651162 PECOS PAC ID: 3476708157 Enrollment ID: I20150408001496 |
| Provider Name | Caren J Jeskey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629401120 PECOS PAC ID: 3476890260 Enrollment ID: I20200729000034 |
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