Provider Demographics
NPI:1669285854
Name:BRUCE-WIDDER, NOELLE MARIE (MSW)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:MARIE
Last Name:BRUCE-WIDDER
Suffix:
Gender:U
Credentials:MSW
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:MARIE
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2802 COHO ST STE 204
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4521
Mailing Address - Country:US
Mailing Address - Phone:608-940-5649
Mailing Address - Fax:
Practice Address - Street 1:2802 COHO ST STE 204
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4521
Practice Address - Country:US
Practice Address - Phone:608-940-5649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132226-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical