Provider Demographics
NPI:1821219676
Name:BUCHLER, JONATHAN J (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:J
Last Name:BUCHLER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAKESHORE CLINIC SUITE 502
Mailing Address - Street 2:3970 N. OAKLAND AVENUE
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211
Mailing Address - Country:US
Mailing Address - Phone:414-241-6434
Mailing Address - Fax:414-332-8596
Practice Address - Street 1:LAKESHORE CLINIC SUITE 502
Practice Address - Street 2:3970 N. OAKLAND AVENUE
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:414-241-6434
Practice Address - Fax:414-332-8596
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7025-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40963700Medicaid