Healthcare Provider Details

I. General information

NPI: 1861387219
Provider Name (Legal Business Name): ALEXIS NASH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS CANFIELD LCSW

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 N GRANDVIEW BLVD STE 102
WAUKESHA WI
53188-1672
US

IV. Provider business mailing address

2310 14TH AVE
KENOSHA WI
53140-1810
US

V. Phone/Fax

Practice location:
  • Phone: 262-513-0700
  • Fax: 888-483-0118
Mailing address:
  • Phone: 224-814-3793
  • Fax:

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:
Title or Position:
Credential:
Phone: