Healthcare Provider Details

I. General information

NPI: 1770077174
Provider Name (Legal Business Name): HAYDEN GRACE KOUKIOS AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W. WISCONSIN AVENUE STE B340
MILWAUKEE WI
53226-5600
US

IV. Provider business mailing address

9000 W. WISCONSIN AVENUE MS 958
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2934
  • Fax: 414-266-6189
Mailing address:
  • Phone: 414-266-7615
  • Fax: 414-266-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number665-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: