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General NPI Number Information
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NPI Number | 1336032648
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Entity Type | Individual
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Provider Name | ALEXA RAE LAURINO
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Gender | Female
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 118 S ADAMS ST
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City | GREEN BAY
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State | WI
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Zip | 54301-4512
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Country | US
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Telephone | 920-215-4858
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Fax |
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Provider Business Mailing Address
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Address Line | 3758 SAND ACRES DR
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City | DE PERE
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State | WI
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Zip | 54115-9360
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Country | US
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Telephone | 920-205-8421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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