Provider Demographics
NPI:1265646863
Name:OVERSHINER, DAVID DUNCAN (BA, SAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DUNCAN
Last Name:OVERSHINER
Suffix:
Gender:M
Credentials:BA, SAC
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Mailing Address - Street 1:2016 KATHY CT
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-4713
Mailing Address - Country:US
Mailing Address - Phone:262-522-7346
Mailing Address - Fax:414-546-6235
Practice Address - Street 1:9330 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2300
Practice Address - Country:US
Practice Address - Phone:414-546-6880
Practice Address - Fax:414-546-6234
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15353131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39177300Medicaid