Provider Demographics
NPI:1851865018
Name:BUDZINSKI, MISTY (LCSW)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:BUDZINSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 MATHEWS RD APT 7
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2448
Mailing Address - Country:US
Mailing Address - Phone:608-284-0844
Mailing Address - Fax:
Practice Address - Street 1:582 FARGO TRL
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562
Practice Address - Country:US
Practice Address - Phone:608-216-4374
Practice Address - Fax:608-716-3148
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9086-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical