Healthcare Provider Details

I. General information

NPI: 1619724671
Provider Name (Legal Business Name): ALEXIS N LIN APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 E PUETZ RD
OAK CREEK WI
53154-3254
US

IV. Provider business mailing address

7330 W LAYTON AVE
MILWAUKEE WI
53220-3849
US

V. Phone/Fax

Practice location:
  • Phone: 414-877-4570
  • Fax: 414-304-8065
Mailing address:
  • Phone: 414-877-4570
  • Fax: 262-244-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number134783
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: