Ellicia Wilder, LPC-IT, SAC-IT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

4482-226 Issued in WI

Practice address

930 W Historic Mitchell St
Milwaukee, WI 53204-3533

Phone

(414) 383-9526

Fax

(414) 671-6606

NPI assigned

Oct 29, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gerald L Ignace Indian Health Center IncGroup PAC ID 5799677282, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gerald L. Ignace Indian Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Milwaukee, WI
  • NPI 1023064086
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635724800000",
    "number": "1861156473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 W HISTORIC MITCHELL ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532043533",
            "telephone_number": "414-383-9526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 W HISTORIC MITCHELL ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532043533",
            "telephone_number": "414-383-9526",
            "fax_number": "414-671-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "ELLICIA",
        "credential": "LPC-IT, SAC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-29",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18729-130",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "4482-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luke Wild, LPC
• Kristen Wilde, MD
• Ana Elizabeth Wilden
• Bridgett Lynn Wilder
• Danyale Lenora Wilder, LPN
• Mary Deloris Wilder, RN
• Shanika J Wilder
• Tamiko Wilder
• Micah Wildes, MD
• Sharon Wildes, R.D.H.

• Mental Health Counselor in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.