Individual
ELLICIA WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-IT, SAC-IT
Contact information
Practice address
930 W HISTORIC MITCHELL ST, MILWAUKEE, WI 53204-3533
(414) 383-9526
(414) 671-6606
Mailing address
930 W HISTORIC MITCHELL ST, MILWAUKEE, WI 53204-3533
(414) 383-9526
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
18729-130
WI
101YM0800X
Mental Health Counselor
Primary
4482-226
WI
Other
Enumeration date
10/29/2021
Last updated
11/01/2021
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