Provider Demographics
NPI:1164727509
Name:CRABB, JUDITH MARIE (NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MARIE
Last Name:CRABB
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S62W35466 PIPER RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:WI
Mailing Address - Zip Code:53119-1265
Mailing Address - Country:US
Mailing Address - Phone:262-993-4379
Mailing Address - Fax:
Practice Address - Street 1:200 W SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9427
Practice Address - Country:US
Practice Address - Phone:262-993-4379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI173-228106H00000X
WI4885-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist