Shelly L Brudnicki, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9882-123 Issued in WI

Practice address

905 E Meinecke Ave Apt C
Milwaukee, WI 53212-3415

Phone

(414) 750-7576

NPI assigned

Mar 14, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rea Therapy

  • Adult Mental Health Clinic/Center
  • Austin, TX
  • NPI 1306578224
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647216000000",
    "number": "1568110955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 E MEINECKE AVE APT C",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123415",
            "telephone_number": "414-750-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 E MEINECKE AVE APT C",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123415",
            "telephone_number": "414-750-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUDNICKI",
        "first_name": "SHELLY",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-14",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "19021",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9882-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Gerald Bruchs, DDS
• Anna Bruckbauer, OTR
• John Bruckbauer, MD
• Julia A. Bruckner, M.D.
• Elinor J Bruders, FNP-BC, NP-C
• Katherine Ann Brueck, M.S.CCC-SLP
• Eric Brueckner, DPT
• Rosemarie M Brueggeman, MD
• Jennifer Danielle Bruening, M.D.
• Tiffany Clark Bruett

• Clinical Social Worker in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.

Verify at the official NPI Registry.