| Ccp Clinic, Llc | |
|
3301 Packerland Dr Ste B De Pere WI 54115-9533 | |
| (920) 234-9240 | |
| Not Available |
| Full Name | Ccp Clinic, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 3301 Packerland Dr Ste B, De Pere, Wisconsin |
| Authorized Official Name and Position | Jaclyn Geitner (CO-OWNER) |
| Authorized Official Contact | 6514911346 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ccp Clinic, Llc 3301 Packerland Dr Ste B De Pere WI 54115-9533 Ph: (651) 491-1346 | Ccp Clinic, Llc 3301 Packerland Dr Ste B De Pere WI 54115-9533 Ph: (920) 234-9240 |
| NPI Number | 1396431714 |
|---|---|
| Provider Enumeration Date | 04/18/2023 |
| Last Update Date | 04/24/2023 |
| Certification Date | 04/24/2023 |
| Medicare PECOS PAC ID | 7214394022 |
|---|---|
| Medicare Enrollment ID | O20230609002780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396431714 | NPI | - | NPPES |
| Provider Name | Jaclyn Nina Geitner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629352844 PECOS PAC ID: 9638432560 Enrollment ID: I20180406000635 |
| Provider Name | Megan Doxtator |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447809561 PECOS PAC ID: 7214361526 Enrollment ID: I20200326001206 |
| Provider Name | Shannon L Gilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477052579 PECOS PAC ID: 9335551860 Enrollment ID: I20230103001856 |
| Provider Name | Maria Recker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922616895 PECOS PAC ID: 3971950528 Enrollment ID: I20231103002298 |
| Provider Name | Victoria Klieforth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174279129 PECOS PAC ID: 2466809710 Enrollment ID: I20231108003440 |
| Provider Name | Kendra E Wuest |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922716927 PECOS PAC ID: 2668820937 Enrollment ID: I20231127002622 |
| Provider Name | Franchesca Carley Vasquez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730821364 PECOS PAC ID: 8426406406 Enrollment ID: I20231201000583 |
| Provider Name | Neeley K Welch-lamers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629322730 PECOS PAC ID: 9032576848 Enrollment ID: I20240209000356 |
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