Provider Demographics
NPI:1902070758
Name:KOEPPL, JUDITH F (ACSW, CICSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:F
Last Name:KOEPPL
Suffix:
Gender:F
Credentials:ACSW, CICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 MONONA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53593
Mailing Address - Country:US
Mailing Address - Phone:608-258-7771
Mailing Address - Fax:608-832-6486
Practice Address - Street 1:4123 MONONA DRIVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53593
Practice Address - Country:US
Practice Address - Phone:608-258-7771
Practice Address - Fax:608-832-6486
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1842 123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40980200Medicaid