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NPI Code Detail

MEDICARE: RONALD T. MENDYKE MSW, LCSW

MEDICARE: RONALD T. MENDYKE MSW, LCSW
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 Worker4069-123WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851324560
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD T. MENDYKE MSW, LCSW
Provider Business Mailing Address
First Line : 2020 W WELLS ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-2720
Country : US
Telephone Number : 414-476-9675
Fax Number :
Provider Business Practice Location Address
First Line : 2020 W WELLS ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-2720
Country : US
Telephone Number : 414-476-9675
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 11/07/2024

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