Healthcare Provider Details

I. General information

NPI: 1952946436
Provider Name (Legal Business Name): ALICIA HERRINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA KULIGOWSKI

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

IV. Provider business mailing address

790 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

V. Phone/Fax

Practice location:
  • Phone: 616-336-3909
  • Fax: 616-336-8830
Mailing address:
  • Phone: 616-336-3909
  • Fax: 616-336-8830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851122589
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: