Provider Demographics
NPI:1124110598
Name:DAVIS, JUDITH ANNE (CADC-D)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CADC-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 GALVIN RD.
Mailing Address - Street 2:PO BOX 447
Mailing Address - City:ABBOTSFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54405
Mailing Address - Country:US
Mailing Address - Phone:715-223-0480
Mailing Address - Fax:715-223-1611
Practice Address - Street 1:106 GALVIN ROAD
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405
Practice Address - Country:US
Practice Address - Phone:715-223-0480
Practice Address - Fax:715-223-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14808101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)