Provider Demographics
NPI:1215078209
Name:DEBBIE S. OLDHAM, LCSW, CADC-D, LLC
Entity type:Organization
Organization Name:DEBBIE S. OLDHAM, LCSW, CADC-D, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW CADC-D
Authorized Official - Phone:262-894-1477
Mailing Address - Street 1:17100 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5950
Mailing Address - Country:US
Mailing Address - Phone:262-894-1477
Mailing Address - Fax:262-754-3712
Practice Address - Street 1:17100 W BLUEMOUND RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5950
Practice Address - Country:US
Practice Address - Phone:262-894-1477
Practice Address - Fax:262-754-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14427101YA0400X
WI2398-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty