Provider Demographics
NPI:1710944962
Name:ROGERS, JUDITH ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:GREIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1370 S. COMMERCIAL ST.
Mailing Address - Street 2:REACH COUNSELING SERVICES
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4636
Mailing Address - Country:US
Mailing Address - Phone:920-722-8150
Mailing Address - Fax:920-722-0142
Practice Address - Street 1:1370 S COMMERCIAL ST
Practice Address - Street 2:REACH COUNSELING SERVICES
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4636
Practice Address - Country:US
Practice Address - Phone:920-722-8150
Practice Address - Fax:920-722-0142
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI244123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39237100Medicaid