Provider Demographics
NPI:1811562739
Name:UTRIE, ANTHONY JAMES (LCSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMES
Last Name:UTRIE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 SEMINOLE CENTRE CT STE C
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5165
Mailing Address - Country:US
Mailing Address - Phone:608-630-8889
Mailing Address - Fax:608-200-7268
Practice Address - Street 1:5930 SEMINOLE CENTRE CT STE C
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5165
Practice Address - Country:US
Practice Address - Phone:608-630-8889
Practice Address - Fax:608-200-7268
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11279-1231041C0700X
WI19383-130101YA0400X
WI1323481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)