Healthcare Provider Details

I. General information

NPI: 1598461022
Provider Name (Legal Business Name): MELISSA OLTMAN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 10TH ST NW STE 2
MILACA MN
56353-1737
US

IV. Provider business mailing address

150 10TH ST NW STE 2
MILACA MN
56353-1737
US

V. Phone/Fax

Practice location:
  • Phone: 320-983-8022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: