Bruce W Retzlaff, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

501 Park Ave
Oconto, WI 54153-1612

Phone

(920) 834-7000

Fax

(920) 834-6889

NPI assigned

Jan 5, 2007

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 8, 2011.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307491200000",
    "number": "1154478634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 PARK AVE",
            "city": "OCONTO",
            "state": "WI",
            "postal_code": "541531612",
            "telephone_number": "920-834-7000",
            "fax_number": "920-834-6889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 PARK AVE",
            "city": "OCONTO",
            "state": "WI",
            "postal_code": "541531612",
            "telephone_number": "920-834-7000",
            "fax_number": "920-834-6889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETZLAFF",
        "first_name": "BRUCE",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2011-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43427200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32980400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42140300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Oconto, WI
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.