=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720971096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALYSSA KLEIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2025
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 E FOREST ST
-----------------------------------------------------
City | OCONOMOWOC
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53066-3707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-286-1151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2547 HONEY CREEK CIR UNIT 518
-----------------------------------------------------
City | EAST TROY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53120-9717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 8419-226
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------