Provider Demographics
NPI:1215073747
Name:BERTONI, JUDY WANG LUE (CSAC, ICS, LPC)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:WANG LUE
Last Name:BERTONI
Suffix:
Gender:F
Credentials:CSAC, ICS, LPC
Other - Prefix:MISS
Other - First Name:JUDY
Other - Middle Name:WANG LUE
Other - Last Name:VANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSAC, CS-IT
Mailing Address - Street 1:12970 W BLUEMOUND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12970 W BLUEMOUND RD STE 200
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2607
Practice Address - Country:US
Practice Address - Phone:262-780-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7102-125101Y00000X, 101YP2500X
WI15464-132101YA0400X
WI15133101YA0400X
WI1710-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42020200Medicaid