Individual
MRS. JUDITH A OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12630 W NORTH AVE BLDG E, BROOKFIELD, WI 53005
(262) 785-1008
(262) 432-9059
Mailing address
12630 W NORTH AVE, BLDG E, BROOKFIELD, WI 53005-4626
(262) 785-1008
(262) 432-9059
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
170-123
WI
1041C0700X
Clinical Social Worker
Primary
170-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39624700
—
WI
Enumeration date
08/01/2006
Last updated
05/30/2018
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