Provider Demographics
NPI:1184618571
Name:DOERSCH, JUDITH MARGARET (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MARGARET
Last Name:DOERSCH
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 1:4456 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8539
Mailing Address - Country:US
Mailing Address - Phone:920-734-2403
Mailing Address - Fax:
Practice Address - Street 1:1478 KENWOOD DR
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1153
Practice Address - Country:US
Practice Address - Phone:920-720-5839
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1775 - 1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical