MEDICARE: DR. ASHLEY J HAKES PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	42-226	WI
2	103TC0700X	Clinical Psychologist	2950-57	WI

General Provider Information

NPI Number	:	1417180084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY J HAKES PSYD

Provider Business Mailing Address
First Line	:	PO BOX 19070
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54307-9070
Country	:	US
Telephone Number	:	920-496-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 HEIGHTS DR
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-6130
Country	:	US
Telephone Number	:	920-496-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	02/10/2023

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