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NPI Code Detail

MEDICARE: MS. ALICIA ANNE STALKER LMFT

MEDICARE: MS. ALICIA ANNE STALKER LMFT
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
1106H00000XMarriage & Family TherapistMFC42067CA
2106H00000XMarriage & Family Therapist166.001066IL

General Provider Information

NPI Number : 1962540716
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALICIA ANNE STALKER LMFT
Provider Business Mailing Address
First Line : 105 E MAIN ST STE 302
Second Line :
City : MORRIS
State : IL
Zip : 60450-2149
Country : US
Telephone Number : 815-322-3238
Fax Number : 708-827-0454
Provider Business Practice Location Address
First Line : 12400 S HARLEM AVE
Second Line : 200
City : PALOS HEIGHTS
State : IL
Zip : 60463-1440
Country : US
Telephone Number : 708-250-2027
Fax Number : 815-710-5100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2007
Last Update Date : 12/07/2023

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