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1134508161 NPI number — JENA RENEE CLUKA LCSW, MSW

NPI Number: 1134508161
Health Care Provider/Practitioner: JENA RENEE CLUKA LCSW, MSW

Information about “1134508161” NPI (JENA RENEE CLUKA LCSW, MSW) exists in 1134508161 in HTML format HTML  |  1134508161 in plain Text format TXT  |  1134508161 in PDF (Portable Document Format) PDF  |  1134508161 in an XML format XML  formats.

NPI Number : 1134508161 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134508161",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CLUKA",
    "FirstName": "JENA",
    "MiddleName": "RENEE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW, MSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ROSCIZEWSKI",
    "OtherFirstName": "JENA",
    "OtherMiddleName": "RENEE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "APSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "920 60TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KENOSHA",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53140-4041",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "262-654-5333",
    "MailingAddressFaxNumber": "262-654-7818",
    "FirstLinePracticeLocationAddress": "8800 WASHINGTON AVE STE 300",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MOUNT PLEASANT",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53406-3705",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "262-633-3591",
    "PracticeLocationAddressFaxNumber": "262-633-2619",
    "EnumerationDate": "05/22/2015",
    "LastUpdateDate": "03/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "129729-121",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "8805123",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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