Healthcare Provider Details

I. General information

NPI: 1649976440
Provider Name (Legal Business Name): ALISSA OLSON LCSW, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N8688 NORTH RD
IXONIA WI
53036-9713
US

IV. Provider business mailing address

N8688 NORTH RD
IXONIA WI
53036-9713
US

V. Phone/Fax

Practice location:
  • Phone: 414-828-5607
  • Fax:
Mailing address:
  • Phone: 414-828-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13109-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17227-132
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: