Provider Demographics
NPI:1972262806
Name:WILLOW & LEAF PLLC
Entity Type:Organization
Organization Name:WILLOW & LEAF PLLC
Other - Org Name:WILLOW & LEAF COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOBROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:872-365-5086
Mailing Address - Street 1:1658 N MILWAUKEE AVE # 3671
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6905
Mailing Address - Country:US
Mailing Address - Phone:872-365-5086
Mailing Address - Fax:800-991-2996
Practice Address - Street 1:1658 N MILWAUKEE AVE # 3671
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6905
Practice Address - Country:US
Practice Address - Phone:872-365-6087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health