Healthcare Provider Details

I. General information

NPI: 1720976640
Provider Name (Legal Business Name): ALICIA DANIELL GRIFFIN CPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3954 N 63RD ST
MILWAUKEE WI
53216-2113
US

IV. Provider business mailing address

3954 N 63RD ST
MILWAUKEE WI
53216-2113
US

V. Phone/Fax

Practice location:
  • Phone: 414-502-7489
  • Fax:
Mailing address:
  • Phone: 414-502-7489
  • Fax: 414-502-7489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: