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Organization
HAZEL GRACE CENTER FOR AUTISM INC.
Active
Organization
HAZEL GRACE CENTER FOR AUTISM INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA MARIE ELLICKSON-ALBERT BCBA (OWNER)
(534) 235-9209
Entity
Organization
Contact information
Practice address
712 S PEARL ST, NEW LONDON, WI 54961-1861
(534) 235-9209
Mailing address
712 S PEARL ST, NEW LONDON, WI 54961-1861
(534) 235-9209
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
07/04/2025
Last updated
09/20/2026
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