=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225057540
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT A CHUCKA PSYD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 12/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3364 S 11TH ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53215-5133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-285-6456
-----------------------------------------------------
Fax | 414-285-6456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3364 S 11TH ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53215-5133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-285-6456
-----------------------------------------------------
Fax | 414-285-6456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2469-057
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------