Provider Demographics
NPI:1639063472
Name:CANNIZZO, ALICIA RENEE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:RENEE
Last Name:CANNIZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 MORRISON ST APT 2W
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3870
Mailing Address - Country:US
Mailing Address - Phone:608-391-1175
Mailing Address - Fax:
Practice Address - Street 1:307 S PATERSON ST STE 120
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3517
Practice Address - Country:US
Practice Address - Phone:608-501-1629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health