Provider Demographics
NPI:1558116673
Name:ALCORTA, ELENA
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:ALCORTA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:INDIGO
Other - Middle Name:
Other - Last Name:ALCORTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5325 WALL ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-7983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 WHALEN RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1765
Practice Address - Country:US
Practice Address - Phone:608-229-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician