Third Wave Wellness, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

THIRD WAVE WELLNESS, LLC

Practice address

636 Church St Ste 418
Evanston, IL 60201-4580

Phone

(773) 484-7140

NPI assigned

Feb 19, 2020

Organization subpart

Yes

Parent organization

THIRD WAVE WELLNESS, LLCAs reported in NPPES

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

Authorized official

Name

Elizabeth Bierbaum Clarke, LCSWNPI 1417156738

Title

Owner / Clinician

Phone

(773) 484-7140

Specialties & licenses 1

Addresses

Part of

Third Wave Wellness LLC

Locations

Practitioners 1

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

• Elizabeth Bierbaum Clarke, LCSW

  • Clinical Social Worker
  • Evanston, IL
  • NPI 1417156738
  NPD Authorized official

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1205469277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST STE 418",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014580",
            "telephone_number": "773-484-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST STE 418",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014580",
            "telephone_number": "773-484-7140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD WAVE WELLNESS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THIRD WAVE WELLNESS, LLC",
        "enumeration_date": "2020-02-19",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "BIERBAUM",
        "authorized_official_title_or_position": "OWNER / CLINICIAN",
        "authorized_official_telephone_number": "773-484-7140",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Talent Theparee, M.D.
• Nigel Christopher Thibodeaux, LCSW
• Kristyn Thielen, APRN
• Kristin E Thieme
• Third Coast Counseling
• Thomas J Chorba MD SC
• Thomas N Hammerman PLLC
• Ann Marie Thomas
• Antoinette Benita Thomas, M.D.
• Anu Thomas, APN-CNP

• Clinical Social Worker in Evanston, IL
• Providers in Evanston, 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 Feb 19, 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.