Provider Demographics
NPI:1073253530
Name:DADEZ, ALECIA LYN
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:LYN
Last Name:DADEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALECIA
Other - Middle Name:LYN
Other - Last Name:DADEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ALECIA LYN BRUGLER
Mailing Address - Street 1:253 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1106
Mailing Address - Country:US
Mailing Address - Phone:715-338-5730
Mailing Address - Fax:
Practice Address - Street 1:742 STERBENZ DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8327
Practice Address - Country:US
Practice Address - Phone:715-386-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7180-26225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist