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General NPI Number Information
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NPI Number | 1255815544
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Entity Type | Individual
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Provider Name | ELLEN STUECKROTH MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 7280 S 13TH ST
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City | OAK CREEK
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State | WI
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Zip | 53154-1831
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Country | US
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Telephone | 262-251-1112
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Fax | 262-251-1113
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Provider Business Mailing Address
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Address Line | W156N8327 PILGRIM RD
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-3776
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Country | US
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Telephone | 262-251-1112
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Fax | 262-251-1113
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2017036694
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11246123
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License Number State | WI
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