Healthcare Provider Details

I. General information

NPI: 1114838828
Provider Name (Legal Business Name): ALEXIS AIDIF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 W VIENNA RD STE B
CLIO MI
48420-2034
US

IV. Provider business mailing address

3520 W VIENNA RD STE B
CLIO MI
48420-2034
US

V. Phone/Fax

Practice location:
  • Phone: 810-584-0553
  • Fax: 999-999-9999
Mailing address:
  • Phone: 810-584-0553
  • Fax: 999-999-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: