Provider Demographics
NPI:1538139282
Name:GHILARDI, ROSE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:M
Last Name:GHILARDI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ROSE
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LCSW
Mailing Address - Street 1:111 S 1ST ST
Mailing Address - Street 2:SUITE #160
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5236
Mailing Address - Country:US
Mailing Address - Phone:608-251-0839
Mailing Address - Fax:608-255-2752
Practice Address - Street 1:111 S 1ST ST
Practice Address - Street 2:SUITE #160
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5236
Practice Address - Country:US
Practice Address - Phone:608-251-0839
Practice Address - Fax:608-255-2752
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1050123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39623600Medicaid
WI20-8734901OtherCORPORATION EIN#