Healthcare Provider Details

I. General information

NPI: 1881880532
Provider Name (Legal Business Name): JUDITH ANN PASKO A.P.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E VETERANS ST
TOMAH WI
54660-3105
US

IV. Provider business mailing address

8812 W HUSTIS CT
MILWAUKEE WI
53224-4731
US

V. Phone/Fax

Practice location:
  • Phone: 608-446-0662
  • Fax:
Mailing address:
  • Phone: 414-353-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1667
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2754-125
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number189-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: