Provider Demographics
NPI:1528001450
Name:HAYES, THOMAS J (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HAYES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1808
Mailing Address - Country:US
Mailing Address - Phone:608-356-9055
Mailing Address - Fax:608-356-5447
Practice Address - Street 1:1002 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1808
Practice Address - Country:US
Practice Address - Phone:608-356-9055
Practice Address - Fax:608-356-5447
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1707-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39287100Medicaid
WI000284264Medicare ID - Type Unspecified
WIR60544Medicare UPIN