Healthcare Provider Details

I. General information

NPI: 1134069917
Provider Name (Legal Business Name): ALEXANDER JACOB HARTIN MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 N PROSPECT AVE
MILWAUKEE WI
53202-6319
US

IV. Provider business mailing address

321 N 70TH ST
WAUWATOSA WI
53213-3835
US

V. Phone/Fax

Practice location:
  • Phone: 414-405-0670
  • Fax:
Mailing address:
  • Phone: 262-490-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8730226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: