Healthcare Provider Details

I. General information

NPI: 1316773518
Provider Name (Legal Business Name): ALICIA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 S TRAFTON ST
TACOMA WA
98409-7144
US

IV. Provider business mailing address

5006 S TRAFTON ST
TACOMA WA
98409-7144
US

V. Phone/Fax

Practice location:
  • Phone: 253-341-6698
  • Fax:
Mailing address:
  • Phone: 253-341-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3887193
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: