Provider Demographics
NPI:1720976640
Name:GRIFFIN, ALICIA DANIELL (CPPS)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DANIELL
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CPPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3954 N 63RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2113
Mailing Address - Country:US
Mailing Address - Phone:414-502-7489
Mailing Address - Fax:414-502-7489
Practice Address - Street 1:3954 N 63RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2113
Practice Address - Country:US
Practice Address - Phone:414-502-7489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist