Provider Demographics
NPI:1851690937
Name:JUDNIC, SHAWNE NICOLE (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:SHAWNE
Middle Name:NICOLE
Last Name:JUDNIC
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5341 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-8175
Mailing Address - Country:US
Mailing Address - Phone:715-325-6914
Mailing Address - Fax:
Practice Address - Street 1:W18105 HEMLOCK RD
Practice Address - Street 2:
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499-8647
Practice Address - Country:US
Practice Address - Phone:715-253-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4264-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional