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General NPI Number Information
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NPI Number | 1962540716
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Entity Type | Individual
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Provider Name | ALICIA ANNE STALKER LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 12400 S HARLEM AVE 200
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1440
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Country | US
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Telephone | 708-250-2027
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Fax | 815-710-5100
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Provider Business Mailing Address
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Address Line | 105 E MAIN ST STE 302
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City | MORRIS
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State | IL
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Zip | 60450-2149
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Country | US
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Telephone | 815-322-3238
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Fax | 708-827-0454
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC42067
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.001066
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License Number State | IL
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