Fifth Star Collective, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

FIFTH STAR COLLECTIVE, LLC

Practice address

2711 N Lawndale Ave Unit 2
Chicago, IL 60647-1127

Phone

(720) 982-9038

NPI assigned

Oct 17, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Connor WilliamsNPI 1336597418

Title

Co-Founder, Senior Consultant

Phone

(720) 982-9038

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Connor Williams, LCSW

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1336597418
  NPD Authorized official

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

{
    "created_epoch": "1602892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605225600000",
    "number": "1104425552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3914 W ALTGELD ST # 2E",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606471004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2711 N LAWNDALE AVE UNIT 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606471127",
            "telephone_number": "720-982-9038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIFTH STAR COLLECTIVE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-17",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CONNOR",
        "authorized_official_title_or_position": "CO-FOUNDER, SENIOR CONSULTANT",
        "authorized_official_telephone_number": "720-982-9038",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED CLINICAL SOCIAL WORKER",
            "identifier": "149.018440",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI",
            "identifier": "1336597418",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Lynn Fierke, P.T. A.
• David Sebastian Fierro, MD
• Katherine Fierstein, OTR
• Renee Zubay Fife, CPNP
• Lori Fifield
• Fig Nutrition LLC
• Jeffrey James Figaro
• Mary Ann Figel, MD
• Kylie Jane Figgins
• Bonnie Fights, L.P.C.

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, 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 Nov 13, 2020; 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.