Individual provider Active NPI

Georgien D. Dudzek, PSYD

  • Psychologist
  • Janesville, WI
National Provider Identifier
1396167177
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3367-57 Issued in WI
Practice address
4517 Woodgate Dr
Janesville, WI 53546-8203
Phone
(608) 580-0031
Fax
(608) 580-0038
NPI assigned
Jan 13, 2014
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 3367-57 WI Primary
Social Worker 104100000X 126734-121 WI
Clinical Social Worker 1041C0700X 8168-123 WI

Addresses

Primary practice location

4517 Woodgate Dr
Janesville, WI 53546-8203

Mailing address

4517 Woodgate Dr
Janesville, WI 53546-8203
Phone (608) 580-0031

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160624000103 WI Practitioner - Clinical Psychologist 6103120365 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
May accept Medicare assignment
Group practices
Georgien Dudzek, Psy.D. LLCGroup PAC ID 3274900550, 3 clinicians

Practice addresses (Care Compare)

111 N Main St
Suite 100
Janesville, WI 53545-3072

4517 Woodgate Dr
Janesville, WI 53546-8203
Phone 6085800031101

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
126734-121WIMDSocial Worker
8168-123WIMDClinical Social Worker
3367WIMDOccupational Therapist
8168WIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Riversedge Chiropractic, LLC CurrentSince Dec 1, 2022 Accepting new patients
Trivium LLC PastSince Jan 12, 2016 Accepting new patients

Locations

111 N Main St
Ste 100
Janesville, WI 53545
Phone (608) 580-0031

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1396167177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4517 WOODGATE DR",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535468203",
            "telephone_number": "608-580-0031",
            "fax_number": "608-580-0038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4517 WOODGATE DR",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535468203",
            "telephone_number": "608-580-0031",
            "fax_number": "608-580-0038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDZEK",
        "first_name": "GEORGIEN",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-13",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "3367-57",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "126734-121",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "8168-123",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Janesville, WI

Sources for this page

Verify at the official NPI Registry.