Provider Demographics
NPI:1154192847
Name:HYTER, EBONY M (MSW, APSW)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:M
Last Name:HYTER
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1808
Mailing Address - Country:US
Mailing Address - Phone:608-356-9055
Mailing Address - Fax:608-268-9780
Practice Address - Street 1:23295 US HWY 14
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-8911
Practice Address - Country:US
Practice Address - Phone:608-647-4705
Practice Address - Fax:608-268-9780
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1330821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical