Healthcare Provider Details

I. General information

NPI: 1669751806
Provider Name (Legal Business Name): ERIN J OLHEISER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 W NETHERWOOD ST STE 6B
OREGON WI
53575
US

IV. Provider business mailing address

185 W NETHERWOOD ST STE 6B
OREGON WI
53575-1100
US

V. Phone/Fax

Practice location:
  • Phone: 608-291-0107
  • Fax: 608-291-0107
Mailing address:
  • Phone: 608-291-0107
  • Fax: 608-291-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4265-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: