Provider Demographics
NPI:1376193136
Name:CHUKWUMA, STEPHANIE (DOCTOR OF COUNSELING)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:CHUKWUMA
Suffix:
Gender:F
Credentials:DOCTOR OF COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16464
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-0464
Mailing Address - Country:US
Mailing Address - Phone:414-246-7550
Mailing Address - Fax:414-982-1335
Practice Address - Street 1:6114 W CAPITOL DR STE 101
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2147
Practice Address - Country:US
Practice Address - Phone:414-246-7550
Practice Address - Fax:414-982-1335
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP1600X, 171M00000X, 363AM0700X, 372600000X, 373H00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1376193136Medicaid