Healthcare Provider Details

I. General information

NPI: 1497677256
Provider Name (Legal Business Name): RAVEN THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E BUFFALO ST STE 302
MILWAUKEE WI
53202-5727
US

IV. Provider business mailing address

2160 S KINNICKINNIC AVE APT 621
MILWAUKEE WI
53207-1344
US

V. Phone/Fax

Practice location:
  • Phone: 608-617-4722
  • Fax:
Mailing address:
  • Phone: 608-617-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: RHEANNA ORTMAN
Title or Position: OWNER
Credential: MS, LPC
Phone: 608-617-4722