Provider Demographics
NPI:1295264034
Name:THIBAULT-HLADKI, ALISHA RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:RENEE
Last Name:THIBAULT-HLADKI
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Gender:F
Credentials:MD
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Mailing Address - Street 1:300 68TH STREET SE
Mailing Address - Street 2:PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548
Mailing Address - Country:US
Mailing Address - Phone:616-456-0842
Mailing Address - Fax:616-559-5864
Practice Address - Street 1:300 68TH STREET SE
Practice Address - Street 2:PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548
Practice Address - Country:US
Practice Address - Phone:616-456-0842
Practice Address - Fax:616-559-5864
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-11-30
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Provider Licenses
StateLicense IDTaxonomies
MI43011119132084P0800X
MI43510320452084P0800X
MI43015038632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry