Provider Demographics
NPI:1538293352
Name:OVREN, CHARLEEN (CSAC)
Entity Type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:
Last Name:OVREN
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2233
Mailing Address - Country:US
Mailing Address - Phone:715-235-4537
Mailing Address - Fax:715-235-4535
Practice Address - Street 1:320 21ST ST N
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2228
Practice Address - Country:US
Practice Address - Phone:715-235-4537
Practice Address - Fax:715-235-4535
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1976101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39394500Medicaid