Provider Demographics
NPI:1578879730
Name:THOMAS, JUDY CHRISTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:CHRISTINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W315S1105 GLACIER PASS
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-3424
Mailing Address - Country:US
Mailing Address - Phone:773-673-8745
Mailing Address - Fax:773-854-5311
Practice Address - Street 1:W315S1105 GLACIER PASS
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-3424
Practice Address - Country:US
Practice Address - Phone:773-673-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0121271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK300219423Medicare PIN
ILIL4624Medicare PIN