Provider Demographics
NPI:1578853628
Name:O'CONNOR, JAMIE LYNNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LYNNE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2845 N 78TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-5020
Mailing Address - Country:US
Mailing Address - Phone:414-801-3945
Mailing Address - Fax:414-466-3206
Practice Address - Street 1:6815 N CAPITOL DRIVE
Practice Address - Street 2:SUITE 208
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2056
Practice Address - Country:US
Practice Address - Phone:414-466-3204
Practice Address - Fax:414-466-3206
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7680-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical