Provider Demographics
NPI:1649006438
Name:CLEARING COLLECTIVE
Entity type:Organization
Organization Name:CLEARING COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-334-0286
Mailing Address - Street 1:6919 N LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-6497
Mailing Address - Country:US
Mailing Address - Phone:608-334-0286
Mailing Address - Fax:
Practice Address - Street 1:6919 N LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-6497
Practice Address - Country:US
Practice Address - Phone:608-334-0286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty