Healthcare Provider Details

I. General information

NPI: 1437095361
Provider Name (Legal Business Name): ALYSSA GRIMSLED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 WEST AVE S
WESTBY WI
54667-1227
US

IV. Provider business mailing address

N169 OLD HIGHWAY 35
STODDARD WI
54658-9717
US

V. Phone/Fax

Practice location:
  • Phone: 414-208-5566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA GRIMSLED
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 414-208-5566