Provider Demographics
NPI:1962945469
Name:TYLKA - OLESEN, CHRIS
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:TYLKA - OLESEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:TYLKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-5030
Mailing Address - Country:US
Mailing Address - Phone:920-236-4700
Mailing Address - Fax:920-236-1157
Practice Address - Street 1:220 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-5030
Practice Address - Country:US
Practice Address - Phone:920-236-4700
Practice Address - Fax:920-236-1157
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126681041C0700X
WI2643171M00000X
WI12132-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator