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SOUTH STREET CLINIC LLC
NPI 1235128356
Psychologist - Clinical in Oconomowoc, WI

Active since October 20, 2005
416 W SOUTH ST, OCONOMOWOC, WI 53066(262) 567-7673(262) 567-3097 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About South Street Clinic Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH STREET CLINIC LLC (NPI 1235128356) is a healthcare organization registered as a clinical in Oconomowoc, Wisconsin and active in the NPI registry since October 2005. The organization lists Anne Alexa Weston, Clinic Owner, as its authorized official.

NPPES Registry Identity

NPI1235128356
Entity TypeOrganization
Primary Taxonomy103TC0700X
Legal Business NameSOUTH STREET CLINIC LLC
Location Address416 W SOUTH STOconomowoc, WI 53066-2755
Mailing Address416 W South StOconomowoc, WI 53066-2755 · (262) 567-7673 · Fax (262) 567-3097
Phone(262) 567-7673
Fax(262) 567-3097
Organization SubpartNo
Authorized OfficialAnne Alexa WestonClinic Owner · (262) 567-7673
Enumeration DateOctober 20, 2005
Last NPPES UpdateAugust 22, 2020
✔ NPI 1235128356 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in WI · 1841
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
416 W SOUTH ST, Oconomowoc, WI 53066
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Other Identifiers 1

Medicaid42217900WI

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CYNTHIA LEE PETERS PHD
Counselor (Addiction (Substance Use Disorder))
416 W SOUTH ST
OCONOMOWOC, WI 53066
Waukesha County (262) 567-7673
MS. MAEJEANNE FANCHER LCSW
Social Worker
416 W SOUTH ST
OCONOMOWOC, WI 53066
Waukesha County (262) 567-7673

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is South Street Clinic LLC's NPI number?

The NPI number for South Street Clinic LLC is 1235128356. It was assigned to this organization in the NPPES registry on October 20, 2005.

Where is South Street Clinic LLC located?

South Street Clinic LLC is located at 416 W South St, Oconomowoc, WI 53066. The listed phone number is (262) 567-7673.

What is South Street Clinic LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for South Street Clinic LLC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.