Healthcare Provider Details

I. General information

NPI: 1164752911
Provider Name (Legal Business Name): ALICIA MARIE WARGOWSKY MA, MLP, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41430 GRAND RIVER AVE STE D
NOVI MI
48375-1876
US

IV. Provider business mailing address

17526 FARMCREST LN
NORTHVILLE MI
48168-2235
US

V. Phone/Fax

Practice location:
  • Phone: 734-521-5611
  • Fax:
Mailing address:
  • Phone: 734-521-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401000577
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-04-1827
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6361005925
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: