Provider Demographics
NPI:1164659330
Name:KUCKUK, JENNIFER S (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:KUCKUK
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 1:8123 MANSION HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4489
Mailing Address - Country:US
Mailing Address - Phone:920-207-9684
Mailing Address - Fax:
Practice Address - Street 1:2995 SUB ZERO PKWY
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-8801
Practice Address - Country:US
Practice Address - Phone:608-556-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health