Healthcare Provider Details

I. General information

NPI: 1578348140
Provider Name (Legal Business Name): ALEXANDRA M KRIOFSKE MAINELLA PHD, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N 55TH ST
MILWAUKEE WI
53208-2102
US

IV. Provider business mailing address

1315 N 55TH ST
MILWAUKEE WI
53208-2102
US

V. Phone/Fax

Practice location:
  • Phone: 414-405-2151
  • Fax:
Mailing address:
  • Phone: 414-405-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: