Provider Demographics
NPI:1396167177
Name:DUDZEK, GEORGIEN D (PSYD)
Entity type:Individual
Prefix:DR
First Name:GEORGIEN
Middle Name:D
Last Name:DUDZEK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 CORNELIA ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-2415
Mailing Address - Country:US
Mailing Address - Phone:608-931-7556
Mailing Address - Fax:
Practice Address - Street 1:111 N MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-3072
Practice Address - Country:US
Practice Address - Phone:608-580-0031
Practice Address - Fax:608-580-0038
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126734-121104100000X
WI8168-1231041C0700X
WI3367103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical