Provider Demographics
NPI:1417744517
Name:WIKTORSKI, ALISHA (BA)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:WIKTORSKI
Suffix:
Gender:
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX G
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-0167
Mailing Address - Country:US
Mailing Address - Phone:802-728-4466
Mailing Address - Fax:802-728-4197
Practice Address - Street 1:PO BOX G
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-0167
Practice Address - Country:US
Practice Address - Phone:802-728-4466
Practice Address - Fax:802-728-4197
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst