Provider Demographics
NPI:1225524630
Name:LIGOCKI, JEAN (MSW, LCSW, CT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:LIGOCKI
Suffix:
Gender:F
Credentials:MSW, LCSW, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GILES ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1815
Mailing Address - Country:US
Mailing Address - Phone:608-572-3469
Mailing Address - Fax:
Practice Address - Street 1:1000 GILES ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1815
Practice Address - Country:US
Practice Address - Phone:608-572-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6594-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical