Provider Demographics
NPI:1134668528
Name:ROWAN TREE PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:ROWAN TREE PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARDELL-WENTWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC, BC-DMT
Authorized Official - Phone:630-849-4350
Mailing Address - Street 1:1010 JORIE BLVD STE 366
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-4476
Mailing Address - Country:US
Mailing Address - Phone:630-849-4350
Mailing Address - Fax:
Practice Address - Street 1:1010 JORIE BLVD STE 366
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4476
Practice Address - Country:US
Practice Address - Phone:630-849-4350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance TherapistGroup - Multi-Specialty