Provider Demographics
NPI:1104863596
Name:YAUCHLER, OLIN KIRK (LCSW)
Entity Type:Individual
Prefix:
First Name:OLIN KIRK
Middle Name:
Last Name:YAUCHLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 SAYLESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189
Mailing Address - Country:US
Mailing Address - Phone:262-928-6900
Mailing Address - Fax:262-928-3815
Practice Address - Street 1:3011 SAYLESVILLE RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189
Practice Address - Country:US
Practice Address - Phone:262-928-6900
Practice Address - Fax:262-928-3815
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13936131101YA0400X
WI71171231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43706200Medicaid