Healthcare Provider Details

I. General information

NPI: 1518624717
Provider Name (Legal Business Name): MADISON KAE HOGUE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 W PERSHING ST
APPLETON WI
54914-6075
US

IV. Provider business mailing address

2171 W PERSHING ST
APPLETON WI
54914-6075
US

V. Phone/Fax

Practice location:
  • Phone: 920-857-9041
  • Fax: 920-857-3366
Mailing address:
  • Phone: 920-857-9041
  • Fax: 920-857-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: