Innersoul Collective LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

INNERSOUL COLLECTIVE LLC

Practice address

2604 Hunters Pond Run Apt 32
Champaign, IL 61820-2664

Phone

(773) 234-6869

NPI assigned

Dec 16, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cashonna Berger

Title

Credentialing Specialist

Phone

(217) 799-1809

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1003623869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 N PROSPECT AVE # 1079",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618221235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 HUNTERS POND RUN APT 32",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618202664",
            "telephone_number": "773-234-6869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNERSOUL COLLECTIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-16",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "BERGER",
        "authorized_official_first_name": "CASHONNA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "217-799-1809"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Champaign, IL
• Providers in Champaign, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.