| Hazel Grace Center For Autism | |
|
106 Lincoln Ave Clintonville WI 54929-1352 | |
| (920) 224-5048 | |
| Not Available |
| Full Name | Hazel Grace Center For Autism |
|---|---|
| Speciality | Behavior Analyst |
| Location | 106 Lincoln Ave, Clintonville, Wisconsin |
| Authorized Official Name and Position | Lisa Marie Ellickson-albert (OWNER) |
| Authorized Official Contact | 9202245048 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hazel Grace Center For Autism 106 Lincoln Ave Clintonville WI 54929-1352 Ph: (920) 224-5048 | Hazel Grace Center For Autism 106 Lincoln Ave Clintonville WI 54929-1352 Ph: (920) 224-5048 |
| NPI Number | 1508756230 |
|---|---|
| Provider Enumeration Date | 07/04/2025 |
| Last Update Date | 07/04/2025 |
| Certification Date | 07/04/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508756230 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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