Provider Demographics
NPI:1407139447
Name:ANDERSON, ALEISHA M (LAC)
Entity Type:Individual
Prefix:
First Name:ALEISHA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2995 S HERMAN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2471
Mailing Address - Country:US
Mailing Address - Phone:414-550-4645
Mailing Address - Fax:
Practice Address - Street 1:900 JOHN NOLEN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1465
Practice Address - Country:US
Practice Address - Phone:414-550-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI716-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist