Provider Demographics
NPI:1225057540
Name:CHUCKA, ROBERT A (PSYD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:CHUCKA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E WISCONSIN AVE
Mailing Address - Street 2:STE 1800
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4232
Mailing Address - Country:US
Mailing Address - Phone:414-289-7155
Mailing Address - Fax:888-937-9789
Practice Address - Street 1:250 E WISCONSIN AVE
Practice Address - Street 2:STE 1800
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4232
Practice Address - Country:US
Practice Address - Phone:414-289-7155
Practice Address - Fax:888-937-9789
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2469-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42197700Medicaid
WI42197700Medicaid