Healthcare Provider Details

I. General information

NPI: 1942607056
Provider Name (Legal Business Name): JUDY LAUDE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W7327 ANDERSON AVE
SHAWANO WI
54166-1143
US

IV. Provider business mailing address

W7327 ANDERSON AVE
SHAWANO WI
54166-1143
US

V. Phone/Fax

Practice location:
  • Phone: 715-526-4700
  • Fax: 715-526-5542
Mailing address:
  • Phone: 715-526-4700
  • Fax: 715-526-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number641-120
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7148-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: