Basic Information
Provider Information | |||||||||
NPI: | 1124251319 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZEMKE | ||||||||
FirstName: | JULIE | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW, CAPSW, CSAC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 199 COUNTY DF # DF | ||||||||
Address2: |   | ||||||||
City: | JUNEAU | ||||||||
State: | WI | ||||||||
PostalCode: | 530399512 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9203863806 | ||||||||
FaxNumber: | 9203863812 | ||||||||
Practice Location | |||||||||
Address1: | 199 COUNTY DF | ||||||||
Address2: |   | ||||||||
City: | JUNEAU | ||||||||
State: | WI | ||||||||
PostalCode: | 530399512 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9203863806 | ||||||||
FaxNumber: | 9203863812 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/03/2009 | ||||||||
LastUpdateDate: | 04/06/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 129090-121 | WI | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 101YA0400X | 15809 | WI | Y |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
ID | Type | State | Issuer | Description | 1124251319 | 05 | WI |   | MEDICAID |