Provider Demographics
NPI:1609405703
Name:NIEMI, ALEXANDRA DAWN (HERD CERTIFIED)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DAWN
Last Name:NIEMI
Suffix:
Gender:F
Credentials:HERD CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4689 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9545
Mailing Address - Country:US
Mailing Address - Phone:920-850-8176
Mailing Address - Fax:
Practice Address - Street 1:N4689 MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-9545
Practice Address - Country:US
Practice Address - Phone:920-850-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician