Alexandra Duvall, LCSW, SAC-IT

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9851-123 Issued in WI

Practice address

540 College St
Medford, WI 54451-2027

Phone

(715) 748-3332

NPI assigned

Jul 16, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1043862386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 ALLEN ST",
            "city": "ATHENS",
            "state": "WI",
            "postal_code": "544119242",
            "telephone_number": "715-650-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 COLLEGE ST",
            "city": "MEDFORD",
            "state": "WI",
            "postal_code": "544512027",
            "telephone_number": "715-748-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUVALL",
        "first_name": "ALEXANDRA",
        "credential": "LCSW, SAC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-16",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "131643",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9851-123",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18807",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Robert Diegel, CRNA
• Steven Todd Dietzman, LAT
• Rachel Dixon, PA-C
• Joshua W Doyle, DDS
• Stephen E Dreier, DC
• Michelle Lynn Dvorak, MS, LAMFT, CSAC
• Ngozi J Ekwueme, MD
• Doreen K Eldred, LCSW
• Sara A Emmerich, RN
• Haley Erl, DNP

• Clinical Social Worker in Medford, WI
• Providers in Medford, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.