Provider Demographics
NPI:1609147875
Name:OLEJNICZAK-LADEN, HELENE GABRIELLE
Entity Type:Individual
Prefix:MS
First Name:HELENE
Middle Name:GABRIELLE
Last Name:OLEJNICZAK-LADEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:O
Other - Last Name:LADEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1244 RUTLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3827
Mailing Address - Country:US
Mailing Address - Phone:608-257-7212
Mailing Address - Fax:608-257-7212
Practice Address - Street 1:675 W WASHINGTON AVE
Practice Address - Street 2:CAPITOL CLINIC
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2637
Practice Address - Country:US
Practice Address - Phone:608-662-5090
Practice Address - Fax:608-662-5091
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1335-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist