Provider Demographics
NPI:1578351409
Name:BEAUDRY, EMILY GAIL (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GAIL
Last Name:BEAUDRY
Suffix:
Gender:
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3881 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53178-9652
Mailing Address - Country:US
Mailing Address - Phone:920-253-5875
Mailing Address - Fax:
Practice Address - Street 1:N17W24222 RIVERWOOD DR STE 170
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1134
Practice Address - Country:US
Practice Address - Phone:262-793-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12259-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical