Provider Demographics
NPI:1760649354
Name:RICHARD A HOHFELER III PSYD, S.C.
Entity Type:Organization
Organization Name:RICHARD A HOHFELER III PSYD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:HOHFELER
Authorized Official - Suffix:III
Authorized Official - Credentials:PSYD
Authorized Official - Phone:262-569-8399
Mailing Address - Street 1:4329 N SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4551
Mailing Address - Country:US
Mailing Address - Phone:262-569-8399
Mailing Address - Fax:
Practice Address - Street 1:10045 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2446
Practice Address - Country:US
Practice Address - Phone:414-351-7151
Practice Address - Fax:414-393-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1295251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41277OtherNATIONAL REGISTER FOR HEALTH SERVICE PROVIDERS IN PSYCHOLOGY
WI39077400Medicaid
WI1295OtherPSYCHOLOGY LICENSE
WI39077400Medicaid