Healthcare Provider Details

I. General information

NPI: 1710893276
Provider Name (Legal Business Name): GROUNDED GROWTH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2747 N 92ND ST
MILWAUKEE WI
53222-4503
US

IV. Provider business mailing address

333 W BROWN DEER RD STE G
BAYSIDE WI
53217-2370
US

V. Phone/Fax

Practice location:
  • Phone: 262-518-9613
  • Fax: 262-404-8426
Mailing address:
  • Phone: 262-518-9613
  • Fax: 262-404-8426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS CONDY
Title or Position: OWNER
Credential: LCSW
Phone: 262-518-9613