Provider Demographics
NPI:1467948844
Name:COLEMAN, ALEXCIS (SAC-IT)
Entity Type:Individual
Prefix:
First Name:ALEXCIS
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-1956
Mailing Address - Country:US
Mailing Address - Phone:414-322-8827
Mailing Address - Fax:
Practice Address - Street 1:6815 W CAPITOL DR STE 217
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216
Practice Address - Country:US
Practice Address - Phone:414-322-8827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI374U00000X
WI3215101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty