Individual
ALEXANDRIA MADISON MONTGOMERY BLACKSTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
40 JEWELERS PARK DR STE 100, NEENAH, WI 54956-3893
(920) 720-6000
Mailing address
40 JEWELERS PARK DR STE 100, NEENAH, WI 54956-3893
(920) 720-6000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7397-226
WI
101YP2500X
Professional Counselor
11656-125
WI
Other
Enumeration date
05/31/2023
Last updated
05/02/2025
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