Provider Demographics
NPI:1932812518
Name:ALEXANDER-WOLF, AARON MICHAEL
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:MICHAEL
Last Name:ALEXANDER-WOLF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 FAIR WINDS LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-7584
Mailing Address - Country:US
Mailing Address - Phone:920-680-2055
Mailing Address - Fax:
Practice Address - Street 1:612 FAIR WINDS LN
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-7584
Practice Address - Country:US
Practice Address - Phone:920-680-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8472-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional