Healthcare Provider Details

I. General information

NPI: 1720171671
Provider Name (Legal Business Name): CHERYL A RUGG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10850 W PARK PLACE, #100
MILWAUKEE WI
53224
US

IV. Provider business mailing address

2843 N MARIETTA AVENUE
MILWAUKEE WI
53211
US

V. Phone/Fax

Practice location:
  • Phone: 262-542-3255
  • Fax: 414-359-1021
Mailing address:
  • Phone: 262-542-3255
  • Fax: 414-359-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2312
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number267-123
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2676-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: