Provider Demographics
NPI:1699446005
Name:LUEDTKE, ABIGAIL MAELLEN (MS, LPC-IT)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:MAELLEN
Last Name:LUEDTKE
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:MRS
Other - First Name:ABIGAIL
Other - Middle Name:MAELLEN
Other - Last Name:BILLMIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3926 PLYMOUTH CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-5212
Mailing Address - Country:US
Mailing Address - Phone:414-559-4241
Mailing Address - Fax:
Practice Address - Street 1:437 S YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2902
Practice Address - Country:US
Practice Address - Phone:608-516-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional