Healthcare Provider Details

I. General information

NPI: 1861865560
Provider Name (Legal Business Name): ALEXIS STIKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 GUNDERSEN DR
ONALASKA WI
54650-8447
US

IV. Provider business mailing address

2014 AVON ST
LA CROSSE WI
54603-2009
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2157-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: