Provider Demographics
NPI:1710221726
Name:STEVENS, JUDY (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:GIORDANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1011 N MAYFAIR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3431
Mailing Address - Country:US
Mailing Address - Phone:414-453-8380
Mailing Address - Fax:
Practice Address - Street 1:1011 N MAYFAIR RD STE 101
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3431
Practice Address - Country:US
Practice Address - Phone:414-453-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4927-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional