Provider Demographics
NPI:1912776634
Name:EVERETT, CHLOE MARIE (SAC-IT)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:MARIE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:MIST
Other - Middle Name:ADALHARD CLAAS
Other - Last Name:EVERETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SAC-IT
Mailing Address - Street 1:5194 E CHERYL PKWY APT 104
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7710
Mailing Address - Country:US
Mailing Address - Phone:608-692-2769
Mailing Address - Fax:
Practice Address - Street 1:131 CLARMAR DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2664
Practice Address - Country:US
Practice Address - Phone:608-318-0932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20461-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)