Healthcare Provider Details

I. General information

NPI: 1467948844
Provider Name (Legal Business Name): ALEXCIS COLEMAN SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 W CAPITOL DR STE 217
MILWAUKEE WI
53216
US

IV. Provider business mailing address

4001 W HEMLOCK ST
MILWAUKEE WI
53209-1956
US

V. Phone/Fax

Practice location:
  • Phone: 414-322-8827
  • Fax:
Mailing address:
  • Phone: 414-322-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3215
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: