Healthcare Provider Details

I. General information

NPI: 1215651773
Provider Name (Legal Business Name): ABIGAIL LIEDL APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W WASHINGTON AVE
MADISON WI
53703-2996
US

IV. Provider business mailing address

345 W WASHINGTON AVE
MADISON WI
53703-2996
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-2095
  • Fax: 608-256-0743
Mailing address:
  • Phone: 608-280-2095
  • Fax: 608-256-0743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128745
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: