Provider Demographics
NPI:1255815544
Name:STUECKROTH, ELLEN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:STUECKROTH
Suffix:
Gender:F
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:W156N8327 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3776
Mailing Address - Country:US
Mailing Address - Phone:262-251-1112
Mailing Address - Fax:262-251-1113
Practice Address - Street 1:7280 S 13TH ST
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1831
Practice Address - Country:US
Practice Address - Phone:262-251-1112
Practice Address - Fax:262-251-1113
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017036694104100000X
1041C0700X, 171M00000X
WI112461231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator