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Organization

CCP CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JACLYN GEITNER MSW, LCSW (CO-OWNER)
(651) 491-1346
Entity
Organization

Contact information

Practice address
3301 PACKERLAND DR STE B, DE PERE, WI 54115-9533
(920) 234-9240
Mailing address
3301 PACKERLAND DR STE B, DE PERE, WI 54115-9533
(651) 491-1346

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
103TC0700X
Clinical Psychologist
Primary
1041C0700X
Clinical Social Worker

Other

Enumeration date
04/18/2023
Last updated
04/03/2025
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