Healthcare Provider Details

I. General information

NPI: 1013297787
Provider Name (Legal Business Name): JODIE LYNN GARCIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODIE ZEMP LCSW

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 FOURIER DR
MADISON WI
53717-1969
US

IV. Provider business mailing address

7827 CARIBOU CT
VERONA WI
53593-9616
US

V. Phone/Fax

Practice location:
  • Phone: 608-662-9327
  • Fax: 608-662-9041
Mailing address:
  • Phone: 608-576-8008
  • Fax: 608-576-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128341-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: