Provider Demographics
NPI:1821082462
Name:YOCIUS, JUDITH A (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:YOCIUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:DEMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1478 KENWOOD CTR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1161
Mailing Address - Country:US
Mailing Address - Phone:920-886-9319
Mailing Address - Fax:920-886-9357
Practice Address - Street 1:1478 KENWOOD CTR
Practice Address - Street 2:SUITE 1
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1161
Practice Address - Country:US
Practice Address - Phone:920-886-9319
Practice Address - Fax:920-886-9357
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3362-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39716900Medicaid
WI39716900Medicaid