Provider Demographics
NPI:1013297787
Name:GARCIA, JODIE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:LYNN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:ZEMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7827 CARIBOU CT
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9616
Mailing Address - Country:US
Mailing Address - Phone:608-576-8008
Mailing Address - Fax:608-576-8008
Practice Address - Street 1:1210 FOURIER DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1969
Practice Address - Country:US
Practice Address - Phone:608-662-9327
Practice Address - Fax:608-662-9041
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128341-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI128341-121OtherADVANCED PRACTICE SOCIAL WORKER