Healthcare Provider Details

I. General information

NPI: 1043039050
Provider Name (Legal Business Name): ALEXIS ANNE MISCO LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HOSFORD ST STE 101
HUDSON WI
54016-9316
US

IV. Provider business mailing address

1590 157TH AVE
CENTURIA WI
54824-7473
US

V. Phone/Fax

Practice location:
  • Phone: 715-836-0064
  • Fax: 715-836-0065
Mailing address:
  • Phone: 920-829-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9342-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: