Provider Demographics
NPI:1730846692
Name:RUECHEL, AMANDA MARY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARY
Last Name:RUECHEL
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 1:306 S SAINT AUGUSTINE ST
Mailing Address - Street 2:SUITE 674
Mailing Address - City:PULASKI
Mailing Address - State:WI
Mailing Address - Zip Code:54162
Mailing Address - Country:US
Mailing Address - Phone:920-588-8146
Mailing Address - Fax:
Practice Address - Street 1:306 S SAINT AUGUSTINE ST
Practice Address - Street 2:SUITE 674
Practice Address - City:PULASKI
Practice Address - State:WI
Practice Address - Zip Code:54162
Practice Address - Country:US
Practice Address - Phone:920-588-8146
Practice Address - Fax:920-214-1056
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-25
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11695-1231041C0700X
WI132532-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical