MEDICARE: ALEXIS KOONCE

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	374J00000X	Doula		WI

General Provider Information

NPI Number	:	1417746058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS KOONCE

Provider Business Mailing Address
First Line	:	8040 W MEDFORD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-3501
Country	:	US
Telephone Number	:	608-520-6110
Fax Number	:

Provider Business Practice Location Address
First Line	:	8040 W MEDFORD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-3501
Country	:	US
Telephone Number	:	608-520-6110
Fax Number	:

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

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	05/01/2025

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Directions to “ ALEXIS KOONCE ” Practice Location

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