Healthcare Provider Details

I. General information

NPI: 1164062782
Provider Name (Legal Business Name): ALEV G ILDIZ PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E ENTERPRISE AVE STE 333
APPLETON WI
54913-7889
US

IV. Provider business mailing address

8569 N ORCHARD CT
SPOKANE WA
99208-6954
US

V. Phone/Fax

Practice location:
  • Phone: 414-502-9023
  • Fax:
Mailing address:
  • Phone: 414-502-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4065-57
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSYC.PY.70089190
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10320
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: