Healthcare Provider Details

I. General information

NPI: 1821730169
Provider Name (Legal Business Name): ALESIA NICOLE GARTHWAIT MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 E MILWAUKEE ST # 1035
JEFFERSON WI
53549-1636
US

IV. Provider business mailing address

148 E MILWAUKEE ST # 1035
JEFFERSON WI
53549-1636
US

V. Phone/Fax

Practice location:
  • Phone: 920-301-7424
  • Fax: 920-541-1059
Mailing address:
  • Phone: 920-301-7424
  • Fax: 920-541-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19431-130
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8485-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: