Provider Demographics
NPI:1497261341
Name:HOARD, CEDRIC DALE (LPC-IT)
Entity Type:Individual
Prefix:
First Name:CEDRIC
Middle Name:DALE
Last Name:HOARD
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20230 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3520
Mailing Address - Country:US
Mailing Address - Phone:414-588-1262
Mailing Address - Fax:
Practice Address - Street 1:12630 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4626
Practice Address - Country:US
Practice Address - Phone:262-785-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3773-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health