Provider Demographics
NPI:1487187050
Name:ALICIA WILDER LLC
Entity Type:Organization
Organization Name:ALICIA WILDER LLC
Other - Org Name:ALLOW THERAPY PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHAULAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-822-9733
Mailing Address - Street 1:1324 LAKE DR SE STE 8
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1673
Mailing Address - Country:US
Mailing Address - Phone:616-929-0745
Mailing Address - Fax:
Practice Address - Street 1:1324 LAKE DR SE STE 8
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1673
Practice Address - Country:US
Practice Address - Phone:616-929-0745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010944251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty