Healthcare Provider Details

I. General information

NPI: 1831768845
Provider Name (Legal Business Name): ALEXANDER KELLNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HALL AVE
MARINETTE WI
54143-1655
US

IV. Provider business mailing address

2500 HALL AVE
MARINETTE WI
54143-1655
US

V. Phone/Fax

Practice location:
  • Phone: 715-732-7700
  • Fax:
Mailing address:
  • Phone: 715-732-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8359-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: