Healthcare Provider Details

I. General information

NPI: 1093523110
Provider Name (Legal Business Name): AE COLLECTIVE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ERIE ST STE 525-2824
CHICAGO IL
60611-2740
US

IV. Provider business mailing address

2307 W WILSON AVE APT 3
CHICAGO IL
60625-7738
US

V. Phone/Fax

Practice location:
  • Phone: 773-649-3002
  • Fax:
Mailing address:
  • Phone: 773-629-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HELEN WYATT
Title or Position: OWNER
Credential: LMFT
Phone: 773-629-4842