Healthcare Provider Details

I. General information

NPI: 1942245592
Provider Name (Legal Business Name): GREGORY A. ALEFF LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TRI PARK WAY
APPLETON WI
54914-1658
US

IV. Provider business mailing address

W6031 BLAZING STAR DR
APPLETON WI
54915-7422
US

V. Phone/Fax

Practice location:
  • Phone: 920-831-7909
  • Fax:
Mailing address:
  • Phone: 920-731-0988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number962-123
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: