Eliese Christine Rucktenwald, M.S.W., LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

7639-123 Issued in WI

Practice address

3900 W Brown Deer Rd
Suite 200
Brown Deer, WI 53209-1220

Phone

(414) 540-1270

Fax

(414) 540-2171

NPI assigned

Jan 24, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Group practices

Abg Wellness Group IncGroup PAC ID 0345536785, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Abg Wellness Group Inc

  • Community/Behavioral Health Agency
  • Milwaukee, WI
  • NPI 1184087389
  Medicare reassignment Care Compare group NPD
• Shorehaven Behavioral Health Inc

  • Child & Adolescent Psychiatry Physician
  • Milwaukee, WI
  • NPI 1598800740
  Medicare reassignment
• Shorehaven Behavioral Health Inc

  • Clinical Psychologist
  • Brown Deer, WI
  • NPI 1891887055
  NPD

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

{
    "created_epoch": "1201132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342569600000",
    "number": "1689851313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 W BROWN DEER RD",
            "address_2": "SUITE 200",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091220",
            "telephone_number": "414-540-1270",
            "fax_number": "414-540-2171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 W BROWN DEER RD",
            "address_2": "SUITE 200",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091220",
            "telephone_number": "414-540-1270",
            "fax_number": "414-540-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCKTENWALD",
        "first_name": "ELIESE",
        "middle_name": "CHRISTINE",
        "credential": "M.S.W., LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-24",
        "last_updated": "2012-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7639-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Don David Rosenberg, MS
• Ian Roudebush
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• Bruce E Rowe, MD
• Racheal Rowlinson
• Tenia Ruffin, DOULA
• John Ruona, RPH
• Nicole Russell
• Latoya Marie Rutley, AAS
• Safeway Transportation Inc

• Clinical Social Worker in Brown Deer, WI
• Providers in Brown Deer, 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 Jul 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.