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General NPI Number Information
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NPI Number | 1871417055
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Entity Type | Organization
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Legal Business Name | INNER HAVEN LLC
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Dates
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Enumeration Date | 08/08/2026
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Last Update Date | 08/08/2026
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Provider Practice Location Address
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Address Line | 5500 W VLIET ST STE D
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City | MILWAUKEE
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State | WI
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Zip | 53208-2120
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Country | US
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Telephone | 414-241-1152
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Fax |
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Provider Business Mailing Address
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Address Line | 1433 E OKLAHOMA AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-2430
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Country | US
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Telephone | 414-241-1152
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN THOMAS OLSTAD
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Credential | APNP
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Telephone | 414-241-1152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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