Healthcare Provider Details

I. General information

NPI: 1134675754
Provider Name (Legal Business Name): ALEXIS WICKE MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 GOLFSIDE RD STE 3
YPSILANTI MI
48197-1145
US

IV. Provider business mailing address

2733 E 12TH ST STE C2
BROOKLYN NY
11235-4672
US

V. Phone/Fax

Practice location:
  • Phone: 248-846-8700
  • Fax:
Mailing address:
  • Phone: 248-846-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401000906
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: