Organization
HAZEL GRACE CENTER FOR AUTISM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA MARIE ELLICKSON-ALBERT BCBA (OWNER)
(920) 224-5048
Entity
Organization
Contact information
Practice address
106 LINCOLN AVE, CLINTONVILLE, WI 54929-1352
(920) 224-5048
Mailing address
106 LINCOLN AVE, CLINTONVILLE, WI 54929-1352
(920) 224-5048
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
07/04/2025
Last updated
07/04/2025
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