Provider Demographics
NPI:1831236694
Name:BESSAC, JUDY A (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:A
Last Name:BESSAC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-1931
Mailing Address - Country:US
Mailing Address - Phone:608-847-6161
Mailing Address - Fax:
Practice Address - Street 1:220 WISCONSIN DELLS PKWY S STE 1
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-8328
Practice Address - Country:US
Practice Address - Phone:608-448-6418
Practice Address - Fax:844-705-0151
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1281 - 1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39645100Medicaid
WI39645100Medicaid