Ccp Clinic, LLC
NPI 1396431714ActiveOrganization· Psychologist, Clinical· De Pere, WI
Psychologist, Clinical in De Pere, Wisconsin, registered in NPPES in April 2023. The authorized official on file is Jaclyn Geitner, MSW, LCSW, Co-Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1396431714 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 18, 2023 |
| Last updated in NPPES | Apr 3, 2025 |
| Certified by provider | Mar 29, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | — | — |
| Counselor, Professional | 101YP2500X | — | — |
| Social Worker, Clinical | 1041C0700X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (WI) |
|---|
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