Provider Demographics
NPI:1336825447
Name:FRISSELL, ALEX (MT-BC, MSC)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:FRISSELL
Suffix:
Gender:M
Credentials:MT-BC, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5133
Mailing Address - Country:US
Mailing Address - Phone:440-867-0016
Mailing Address - Fax:
Practice Address - Street 1:2642 UNION ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5133
Practice Address - Country:US
Practice Address - Phone:440-867-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI333-38225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist