South Street Clinic LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1841 Issued in WI

Legal business name

SOUTH STREET CLINIC LLC

Practice address

416 W South St
Oconomowoc, WI 53066-2755

Phone

(262) 567-7673

Fax

(262) 567-3097

NPI assigned

Oct 20, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Anne Alexa Weston, PHD

Title

Clinic Owner

Phone

(262) 567-7673

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Jennifer Lynn Christeson, PHD

  • Psychologist
  • Greenfield, WI
  • NPI 1437146222
  NPD (past)

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235128356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 W SOUTH ST",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530662755",
            "telephone_number": "262-567-7673",
            "fax_number": "262-567-3097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 W SOUTH ST",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530662755",
            "telephone_number": "262-567-7673",
            "fax_number": "262-567-3097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH STREET CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WESTON",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "ALEXA",
        "authorized_official_title_or_position": "CLINIC OWNER",
        "authorized_official_telephone_number": "262-567-7673",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "1841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42217900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Franklin L Smith, MD
• Rachel Smith, LPC-IT
• Megan Sobotik
• Louis John Soefker Jr., RPH
• Solidaritus Health Wisconsin SC
• Mark S Spankowski, OD
• Speechworks LLC
• Carrey Spencer, RDH
• Samantha Sporleder, OTA
• Ana Sprecher

• Clinical Psychologist in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.