Petracore Wellness LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PETRACORE WELLNESS LLC

Practice address

1577 Raymond Dr Apt 104
Naperville, IL 60563-9702

Phone

(219) 242-1451

NPI assigned

Mar 16, 2022

Organization subpart

No

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

Authorized official

Name

Stephanie Lynn Clymer, LCSW

Title

Owner

Phone

(219) 242-1451

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1647388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1770231037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1577 RAYMOND DR APT 104",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605639702",
            "telephone_number": "219-242-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1577 RAYMOND DR APT 104",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605639702",
            "telephone_number": "219-242-1451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRACORE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-16",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "CLYMER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-242-1451",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.petracorewellness.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "address_1": "1577 Raymond Dr Apt 104",
            "city": "Naperville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605639702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michele Lynn Petersmark, LCPC
• Anthony Peterson, MD
• Daniel Chad Peterson, LCPC
• Julie Easton Peterson, LCSW
• Melissa C Peterson, DPT
• Peter Bill Petratos, MD
• Geralyn Petrauskas, SLP
• Joseph Edward Petrauskas, DDS
• Jasmina Petreva
• Neila Petrovic

• Community/Behavioral Health Agency in Naperville, IL
• Providers in Naperville, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.