Healthcare Provider Details

I. General information

NPI: 1861464729
Provider Name (Legal Business Name): LYNN M OLLSWANG ACSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MERELYN L MANEGOLD

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 E. WEBSTER PLACE SUITE 203
MILWAUKEE WI
53211-4253
US

IV. Provider business mailing address

2524 E. WEBSTER PL. SUITE 203
MILWAUKEE WI
53211-4253
US

V. Phone/Fax

Practice location:
  • Phone: 414-964-9200
  • Fax: 414-964-4816
Mailing address:
  • Phone: 414-964-9200
  • Fax: 414-964-4816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1353123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: