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NPI Code Detail

MEDICARE: LORI A RUNGE MSW

MEDICARE: LORI A RUNGE MSW
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 Worker1984-121WI

General Provider Information

NPI Number : 1093097032
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI A RUNGE MSW
Provider Business Mailing Address
First Line : 2625 N WEIL ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3060
Country : US
Telephone Number : 414-962-1200
Fax Number : 414-962-2605
Provider Business Practice Location Address
First Line : 2625 N WEIL ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3060
Country : US
Telephone Number : 414-962-1200
Fax Number : 414-962-2605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2011
Last Update Date : 09/08/2016

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