Provider Demographics
NPI:1295513158
Name:HUGHES, GRACE ANNE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4458
Mailing Address - Country:US
Mailing Address - Phone:608-615-1023
Mailing Address - Fax:608-615-1063
Practice Address - Street 1:605 4TH ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4458
Practice Address - Country:US
Practice Address - Phone:608-615-1023
Practice Address - Fax:608-615-1063
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7458-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health