Provider Demographics
NPI:1740226042
Name:GILBERT, JUDITH ANN (ACSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:GILBERT
Suffix:
Gender:F
Credentials:ACSW, LCSW
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW, ACSW
Mailing Address - Street 1:4633 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-4220
Mailing Address - Country:US
Mailing Address - Phone:262-652-7222
Mailing Address - Fax:262-652-1734
Practice Address - Street 1:4633 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-4220
Practice Address - Country:US
Practice Address - Phone:262-652-7222
Practice Address - Fax:262-652-1734
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI781 -123101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI935558OtherPHCS
WI306112775OtherUNITED BEHAVIORAL HEALTH
WI1740226042Medicaid
WI447800004Medicare PIN