Provider Demographics
NPI:1437614559
Name:CLEMM, ALEICA
Entity Type:Individual
Prefix:
First Name:ALEICA
Middle Name:
Last Name:CLEMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 PARKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15210-2517
Mailing Address - Country:US
Mailing Address - Phone:412-626-0138
Mailing Address - Fax:412-774-0369
Practice Address - Street 1:415 PARKWOOD RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15210-2517
Practice Address - Country:US
Practice Address - Phone:412-626-0138
Practice Address - Fax:412-774-0369
Is Sole Proprietor?:No
Enumeration Date:2019-02-02
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA41933601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA832733014Medicaid