Hazel Grace Center for Autism

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

HAZEL GRACE CENTER FOR AUTISM

Practice address

106 Lincoln Ave
Clintonville, WI 54929-1352

Phone

(920) 224-5048

NPI assigned

Jul 4, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa Marie Ellickson-Albert, BCBANPI 1376232082

Title

Owner

Phone

(920) 224-5048

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Marie Ellickson-Albert, MA, BCBA

  • Behavior Analyst
  • Shawano, WI
  • NPI 1376232082
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751587200000",
    "number": "1508756230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 LINCOLN AVE",
            "city": "CLINTONVILLE",
            "state": "WI",
            "postal_code": "549291352",
            "telephone_number": "920-224-5048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 LINCOLN AVE",
            "city": "CLINTONVILLE",
            "state": "WI",
            "postal_code": "549291352",
            "telephone_number": "920-224-5048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZEL GRACE CENTER FOR AUTISM",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-04",
        "last_updated": "2025-07-04",
        "certification_date": "2025-07-04",
        "status": "A",
        "authorized_official_last_name": "ELLICKSON-ALBERT",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-224-5048",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Gray, MD
• Griebenow Eyecare, S.C.
• Cindy Griswold, NP
• Peggy M Hammond
• Susan Hatfield, RN, RCS
• Dana Marie Hintz, LPN
• Cassandra L Hoffman, OTR
• Jen'S Arc Angels, LLC
• John B. Dewolf, III, D.M.D., S.C.
• Karen Agnete Johnson, DDS

• Behavior Analyst in Clintonville, WI
• Providers in Clintonville, WI by specialty
• Behavior Analyst in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.