Third Wave Wellness, LLC

NPI #1205469277 in Evanston, Illinois

Provider Information

NPI Number: 1205469277
Entity Type: Organization
Organization Name: Third Wave Wellness, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: THIRD WAVE WELLNESS, LLC
Primary Specialty: Social Worker - Clinical
Enumeration Date: Feb 19, 2020
Last Updated: Feb 19, 2020

Practice Location

Address: 636 CHURCH ST STE 418
City: Evanston
State: Illinois
ZIP Code: 60201-4580
Phone: (773) 484-7140

Authorized Official

Name: ELIZABETH BIERBAUM CLARKE, LCSW
Title: OWNER / CLINICIAN
Phone: (773) 484-7140

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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