Healthcare Provider Details

I. General information

NPI: 1992599872
Provider Name (Legal Business Name): ELIZABETH HOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6570 AUTUMN BLAZE TRL
SOBIESKI WI
54171-3501
US

IV. Provider business mailing address

733 SECOND AVE
KOTZEBUE AK
99752
US

V. Phone/Fax

Practice location:
  • Phone: 920-615-4473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: