Healthcare Provider Details

I. General information

NPI: 1346833795
Provider Name (Legal Business Name): LISA MARIE LUDWIG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W OMAHA ST
WASHBURN WI
54891-4557
US

IV. Provider business mailing address

PO BOX 291
MANITOWISH WATERS WI
54545-0291
US

V. Phone/Fax

Practice location:
  • Phone: 715-260-4867
  • Fax: 715-200-5008
Mailing address:
  • Phone: 715-216-0486
  • Fax: 715-200-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11491-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: