Provider Demographics
NPI:1639513401
Name:OLLENDICK, LORI L (LMHC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:OLLENDICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:L
Other - Last Name:BRUFLODT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 CENTURY DR STE 5
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-3771
Mailing Address - Country:US
Mailing Address - Phone:563-590-5998
Mailing Address - Fax:563-726-7384
Practice Address - Street 1:805 CENTURY DR STE 5
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-3771
Practice Address - Country:US
Practice Address - Phone:563-590-5998
Practice Address - Fax:563-726-7384
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1639513401Medicaid