Provider Demographics
NPI:1770779894
Name:KORDA, RANDY J (MS, LMFT)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:J
Last Name:KORDA
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 BELIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2617
Mailing Address - Country:US
Mailing Address - Phone:608-238-2928
Mailing Address - Fax:608-238-2930
Practice Address - Street 1:5515 BELIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2617
Practice Address - Country:US
Practice Address - Phone:608-238-2928
Practice Address - Fax:608-238-2930
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI772-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist