Provider Demographics
NPI:1770219149
Name:RYBICKI, JUDITH ANN (LAC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:RYBICKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 MAIN ST 2E
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302
Mailing Address - Country:US
Mailing Address - Phone:786-877-9354
Mailing Address - Fax:920-544-5166
Practice Address - Street 1:1640 MAIN ST 2E
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302
Practice Address - Country:US
Practice Address - Phone:920-544-5166
Practice Address - Fax:920-544-5166
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI231-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist