Provider Demographics
NPI:1194536516
Name:RAMOS, LUKE (SAC-IT)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:RAMOS
Suffix:
Gender:M
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 S CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1439
Mailing Address - Country:US
Mailing Address - Phone:304-888-9522
Mailing Address - Fax:
Practice Address - Street 1:S22W22660 BROADWAY
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-8100
Practice Address - Country:US
Practice Address - Phone:262-933-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20733130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)