Provider Demographics
NPI:1124481973
Name:OELKE, WILLIAM
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:OELKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:OELKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:2910 ENLOE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-4539
Mailing Address - Country:US
Mailing Address - Phone:715-808-8555
Mailing Address - Fax:715-808-8533
Practice Address - Street 1:2910 ENLOE ST STE 103
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-4539
Practice Address - Country:US
Practice Address - Phone:715-808-8555
Practice Address - Fax:715-808-8533
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1385101YM0800X
WI140-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health