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General NPI Number Information
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NPI Number | 1578351409
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Entity Type | Individual
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Provider Name | EMILY GAIL BEAUDRY MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | N17W24222 RIVERWOOD DR STE 170
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City | WAUKESHA
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State | WI
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Zip | 53188-1134
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Country | US
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Telephone | 262-793-0961
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Fax |
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Provider Business Mailing Address
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Address Line | N3881 LIBERTY ST
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City | SULLIVAN
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State | WI
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Zip | 53178-9652
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Country | US
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Telephone | 920-253-5875
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12259-123
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License Number State | WI
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