Healthcare Provider Details

I. General information

NPI: 1043957616
Provider Name (Legal Business Name): OLIVIA NICOLE GIAMMANCO LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 REGENCY CT STE 200A
BROOKFIELD WI
53045-6167
US

IV. Provider business mailing address

924 E JUNEAU AVE APT 213
MILWAUKEE WI
53202-2748
US

V. Phone/Fax

Practice location:
  • Phone: 855-607-8242
  • Fax:
Mailing address:
  • Phone: 630-842-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9340-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: