Healthcare Provider Details

I. General information

NPI: 1447923024
Provider Name (Legal Business Name): OLIVIA BATIEN DECLEENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S CENTRAL AVE
MARSHFIELD WI
54449-4106
US

IV. Provider business mailing address

725 S CENTRAL AVE
MARSHFIELD WI
54449-4106
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-2729
  • Fax:
Mailing address:
  • Phone: 715-387-2729
  • 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: