1205893005 NPI number — MS. JUDITH E BORREE LCSW

Table of content: MS. JUDITH E BORREE LCSW (NPI 1205893005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205893005 NPI number — MS. JUDITH E BORREE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORREE
Provider First Name:
JUDITH
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205893005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6510 GRAND TETON PLZ
Provider Second Line Business Mailing Address:
SUITE 406
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53719-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-833-9290
Provider Business Mailing Address Fax Number:
608-833-9691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6510 GRAND TETON PLZ
Provider Second Line Business Practice Location Address:
SUITE 406
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53719-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-833-9290
Provider Business Practice Location Address Fax Number:
608-833-9691
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1057-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0023840027 . This is a "WI MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 999000299 . This is a "WPS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 39276800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10539 . This is a "DEAN HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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