Healthcare Provider Details

I. General information

NPI: 1477465607
Provider Name (Legal Business Name): OLIVIA ANNE VAN LAANEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 N 16TH ST
MILWAUKEE WI
53233-2160
US

IV. Provider business mailing address

560 N 16TH ST
MILWAUKEE WI
53233-2160
US

V. Phone/Fax

Practice location:
  • Phone: 414-288-5790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: