Provider Demographics
NPI:1578047569
Name:RODRIGUEZ-BUCK, TANA J (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TANA
Middle Name:J
Last Name:RODRIGUEZ-BUCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30428 BEACHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-3455
Mailing Address - Country:US
Mailing Address - Phone:920-723-7666
Mailing Address - Fax:
Practice Address - Street 1:10201 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2136
Practice Address - Country:US
Practice Address - Phone:920-723-7666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7037-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional