Healthcare Provider Details

I. General information

NPI: 1215078209
Provider Name (Legal Business Name): DEBBIE S. OLDHAM, LCSW, CADC-D, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 W BLUEMOUND RD SUITE 204
BROOKFIELD WI
53005-5950
US

IV. Provider business mailing address

17100 W BLUEMOUND RD SUITE 204
BROOKFIELD WI
53005-5950
US

V. Phone/Fax

Practice location:
  • Phone: 262-894-1477
  • Fax: 262-754-3712
Mailing address:
  • Phone: 262-894-1477
  • Fax: 262-754-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14427
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2398-123
License Number StateWI

VIII. Authorized Official

Name: DEBBIE S OLDHAM
Title or Position: OWNER
Credential: LCSW CADC-D
Phone: 262-894-1477