Healthcare Provider Details

I. General information

NPI: 1588557672
Provider Name (Legal Business Name): COLABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W CLAIREMONT AVE
EAU CLAIRE WI
54701-4503
US

IV. Provider business mailing address

1101 W CLAIREMONT AVE STE 2E
EAU CLAIRE WI
54701-6252
US

V. Phone/Fax

Practice location:
  • Phone: 715-831-2104
  • Fax:
Mailing address:
  • Phone: 507-993-0437
  • Fax: 507-993-0437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALICIA MEGAN DEAN
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 507-993-0437