Doctor Name: | JESSICA OLLMAN |
NPI Number: | 1073859260 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1257-226 |
Business Practice Address: | 121 W Main St Port Washington, WI - 530741813 |
Business Phone Number: | 2622848148 |
Business Fax Number: | 2622848209 |
Mailing Address: | 121 W Main St, PORT WASHINGTON |
State: | WI |
Postal Code: | 530741813 |
Phone Number: | 2622848148 |
Fax Number: | 2622848209 |
NPI Enumeration Date: | 12/17/2012 |
NPI Last Update Date: | 04/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 1257-226 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |