Provider Demographics
NPI:1588648596
Name:OLWAN, DENA Z (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:Z
Last Name:OLWAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 DOUGLAS ST STE 504
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1471
Mailing Address - Country:US
Mailing Address - Phone:712-258-1000
Mailing Address - Fax:712-252-1100
Practice Address - Street 1:401 DOUGLAS STREET
Practice Address - Street 2:SUITE 504
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-1471
Practice Address - Country:US
Practice Address - Phone:712-258-1000
Practice Address - Fax:712-252-1100
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00703103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2157180Medicaid
IA2157180Medicaid