MEDICARE: ALICIA ANN FISHLOCK MSW, CAPSW, CSAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	19699-130	WI
2	101YM0800X	Mental Health Counselor	135655	WI

General Provider Information

NPI Number	:	1710322037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA ANN FISHLOCK MSW, CAPSW, CSAC

Provider Business Mailing Address
First Line	:	N3152 STATE ROAD 81
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-8821
Country	:	US
Telephone Number	:	608-328-9352
Fax Number	:	608-328-9480

Provider Business Practice Location Address
First Line	:	N3152 STATE ROAD 81
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-8821
Country	:	US
Telephone Number	:	608-328-9312
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	02/27/2026

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