Healthcare Provider Details

I. General information

NPI: 1184543050
Provider Name (Legal Business Name): AGIBSON CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 SHROEDER ROAD
MADISON WI
53711
US

IV. Provider business mailing address

14 PINTAIL CIR
MADISON WI
53717-1807
US

V. Phone/Fax

Practice location:
  • Phone: 608-453-8010
  • Fax:
Mailing address:
  • Phone: 608-453-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALEXI GIBSON
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 608-453-8010