Healthcare Provider Details

I. General information

NPI: 1114831617
Provider Name (Legal Business Name): OLIVIA MECHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7878 N 60TH ST
MILWAUKEE WI
53223-4109
US

IV. Provider business mailing address

419 W MONROE ST
PORT WASHINGTON WI
53074-1223
US

V. Phone/Fax

Practice location:
  • Phone: 262-236-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14378401
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: