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General NPI Number Information
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NPI Number | 1912205246
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Entity Type | Individual
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Provider Name | ALEXANDER N ANNIS ED.S, M.ED
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Gender | Male
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 405 E FOREST ST
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3707
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Country | US
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Telephone | 262-468-8990
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Fax |
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Provider Business Mailing Address
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Address Line | 1391 FOREST VIEW LN
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3493
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Country | US
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Telephone | 262-468-8990
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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 | 0701006974
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8283
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8460
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License Number State | WI
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