Healthcare Provider Details

I. General information

NPI: 1225944689
Provider Name (Legal Business Name): ALYSSA LEMIRANDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10173 US HIGHWAY 14
MAZOMANIE WI
53560-9587
US

IV. Provider business mailing address

S11610 HAZELNUT RD
SPRING GREEN WI
53588-9626
US

V. Phone/Fax

Practice location:
  • Phone: 608-767-2251
  • Fax:
Mailing address:
  • Phone: 608-767-2251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3001030292
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: