Provider Demographics
NPI:1053836262
Name:HODGES, RICHARD JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:HODGES
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8026 SOUTHERN HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-8979
Mailing Address - Country:US
Mailing Address - Phone:262-385-4007
Mailing Address - Fax:
Practice Address - Street 1:6058 S. CHESTNUT ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818
Practice Address - Country:US
Practice Address - Phone:608-342-4853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2150-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional