Provider Demographics
NPI:1336447127
Name:ALEXANDER, BAINE B (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:BAINE
Middle Name:B
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1176
Mailing Address - Country:US
Mailing Address - Phone:608-935-2838
Mailing Address - Fax:608-935-9227
Practice Address - Street 1:6602 GRAND TETON PLZ
Practice Address - Street 2:STE 100
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1091
Practice Address - Country:US
Practice Address - Phone:608-828-3636
Practice Address - Fax:608-828-3637
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4518-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100015037Medicaid