Provider Demographics
NPI:1780767848
Name:ROEMER, JUDY MARIE (LPC)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:MARIE
Last Name:ROEMER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23825
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-3825
Mailing Address - Country:US
Mailing Address - Phone:920-272-8234
Mailing Address - Fax:920-437-4067
Practice Address - Street 1:1825 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2316
Practice Address - Country:US
Practice Address - Phone:920-272-8234
Practice Address - Fax:920-437-4067
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3542-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40989700Medicaid