Provider Demographics
NPI:1114659174
Name:CONDY, ALEXIS (APSW, SAC-IT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:CONDY
Suffix:
Gender:F
Credentials:APSW, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12540 DUNCAN LN UNIT 107
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-8760
Mailing Address - Country:US
Mailing Address - Phone:920-838-3698
Mailing Address - Fax:
Practice Address - Street 1:2607 N GRANDVIEW BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1690
Practice Address - Country:US
Practice Address - Phone:262-313-8339
Practice Address - Fax:262-910-1653
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132928-121101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor