Healthcare Provider Details

I. General information

NPI: 1205411808
Provider Name (Legal Business Name): WATCHWORD CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N WABASH AVE BLDG 1308
CHICAGO IL
60602-1903
US

IV. Provider business mailing address

111 N WABASH AVE STE 1308
CHICAGO IL
60602-1903
US

V. Phone/Fax

Practice location:
  • Phone: 312-772-4832
  • Fax:
Mailing address:
  • Phone: 312-772-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: RACHEL MOLOSKY
Title or Position: FOUNDER/LCSW
Credential: LCSW
Phone: 312-772-4832