Provider Demographics
NPI:1962559641
Name:LEMKE, JUDY (LCSW, LPC)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:LEMKE
Suffix:
Gender:F
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-0442
Mailing Address - Country:US
Mailing Address - Phone:715-966-0962
Mailing Address - Fax:
Practice Address - Street 1:3600 STEWART AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3944
Practice Address - Country:US
Practice Address - Phone:715-842-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3786-1231041C0700X
WI1418-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3786-123OtherSTATE LICENSE
WI1418-125OtherLPC