Healthcare Provider Details

I. General information

NPI: 1962540716
Provider Name (Legal Business Name): ALICIA ANNE STALKER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA ANNE GALLICHIO LMFT

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E MAIN ST STE 302
MORRIS IL
60450-2149
US

IV. Provider business mailing address

105 E MAIN ST STE 302
MORRIS IL
60450-2149
US

V. Phone/Fax

Practice location:
  • Phone: 815-322-3238
  • Fax: 708-827-0454
Mailing address:
  • Phone: 815-322-3238
  • Fax: 708-827-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.001066
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC42067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: