Provider Demographics
NPI:1982614152
Name:LONSDORF, BARBARA J (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:LONSDORF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 MCINDOE ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5083
Mailing Address - Country:US
Mailing Address - Phone:715-848-3031
Mailing Address - Fax:715-848-5008
Practice Address - Street 1:614 N 3RD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2913
Practice Address - Country:US
Practice Address - Phone:715-848-3031
Practice Address - Fax:715-848-5008
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1324-1231041C0700X
WI120-124106H00000X
WI934-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39208000Medicaid