Provider Demographics
NPI:1154353894
Name:ZABRISKIE, RICHARD (MSW, LCSW, CADC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ZABRISKIE
Suffix:
Gender:M
Credentials:MSW, LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1136
Mailing Address - Country:US
Mailing Address - Phone:608-643-3663
Mailing Address - Fax:608-643-5014
Practice Address - Street 1:560 4TH SREET
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1541
Practice Address - Country:US
Practice Address - Phone:608-643-3663
Practice Address - Fax:608-643-5014
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1451-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39289900Medicaid
WIP91828Medicare UPIN