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Contact Information

CCP CLINIC, LLC
3301 PACKERLAND DR STE B
DE PERE, WI54115-9533
 Phone: 920-234-9240
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Professional

101YP2500X
Indicates primary specialty

NPI Profile & details for CCP CLINIC, LLC

NPI Number 1396431714
LBN Legal business name CCP CLINIC, LLC
Authorized official JACLYN GEITNER - (CO-OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/18/2023
Last updated 04/03/2025 - More than a year ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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