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NPI Code Detail

MEDICARE: MS. ELISE MAYER ROUDEBUSH LCSW

MEDICARE: MS. ELISE MAYER ROUDEBUSH LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker449-124WI
21041C0700XClinical Social Worker1890-123WI

General Provider Information

NPI Number : 1861509127
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELISE MAYER ROUDEBUSH LCSW
Provider Business Mailing Address
First Line : 1219 N CASS ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-2770
Country : US
Telephone Number : 414-291-9487
Fax Number : 414-291-9975
Provider Business Practice Location Address
First Line : 1219 N CASS ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-2770
Country : US
Telephone Number : 414-291-9487
Fax Number : 414-291-9975
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2006
Last Update Date : 07/08/2007

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1124135231 — MS. SHARON ELIZABETH THYNE LCSW
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Directions to “ MS. ELISE MAYER ROUDEBUSH LCSW” Practice Location

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