Provider Demographics
NPI:1134508161
Name:CLUKA, JENA RENEE (LCSW, MSW)
Entity Type:Individual
Prefix:MRS
First Name:JENA
Middle Name:RENEE
Last Name:CLUKA
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:MS
Other - First Name:JENA
Other - Middle Name:RENEE
Other - Last Name:ROSCIZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW
Mailing Address - Street 1:920 60TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4041
Mailing Address - Country:US
Mailing Address - Phone:262-654-5333
Mailing Address - Fax:262-654-7818
Practice Address - Street 1:920 60TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-4041
Practice Address - Country:US
Practice Address - Phone:262-654-5333
Practice Address - Fax:262-654-7818
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129729-121104100000X
WI88051231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker