Individual
ROBERTA A BRONECKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
124 GRAYSIDE AVE, MAUSTON, WI 53948-1913
(608) 847-7575
(608) 847-3096
Mailing address
PO BOX 359, MAUSTON, WI 53948-0359
(608) 847-7575
(608) 847-3096
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
7163
WI
1041C0700X
Clinical Social Worker
Primary
7163-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013375104
AGENCY NPI NUMBER
WI
01
—
11988111
CAQH
—
05
—
40983800
—
WI
Enumeration date
06/10/2005
Last updated
05/23/2019
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