Active NPI
Jennifer Kukuk
- Social Worker
- Tomah, WI
National Provider Identifier
1174243281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 9303
- Practice address
- 500 E Veterans St
Tomah, WI 54660-3105 - Phone
- (608) 372-3971
- Fax
- (608) 372-1779
- NPI assigned
- Aug 30, 2022
- Reactivated
- Nov 15, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 9303 | NC | Primary |
Addresses
Primary practice location
500 E Veterans St
Tomah, WI 54660-3105
Mailing address
W11421 Spaulding Rd
Black River Falls, WI 54615-5616
Phone (608) 372-3971
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9303 | NC | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668470400000",
"number": "1174243281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W11421 SPAULDING RD",
"city": "BLACK RIVER FALLS",
"state": "WI",
"postal_code": "546155616",
"telephone_number": "608-372-3971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 E VETERANS ST",
"city": "TOMAH",
"state": "WI",
"postal_code": "546603105",
"telephone_number": "608-372-3971",
"fax_number": "608-372-1779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUKUK",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-30",
"last_updated": "2022-11-15",
"certification_date": "2022-11-15",
"deactivation_date": "2022-10-20",
"reactivation_date": "2022-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NC",
"license": "9303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tomah, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.