MEDICARE: MR. ALEX HARTWELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	420-123	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083613517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEX HARTWELL LCSW

Provider Business Mailing Address
First Line	:	5225 N IRONWOOD RD
Second Line	:	STE 118
City	:	GLENDALE
State	:	WI
Zip	:	53217-4909
Country	:	US
Telephone Number	:	414-308-1091
Fax Number	:	414-308-1092

Provider Business Practice Location Address
First Line	:	5225 N IRONWOOD RD
Second Line	:	STE 118
City	:	GLENDALE
State	:	WI
Zip	:	53217-4909
Country	:	US
Telephone Number	:	414-308-1091
Fax Number	:	414-308-1092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/18/2011

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