Provider Demographics
NPI:1679669113
Name:OLDHAM, DEBBIE S (LCSW, CADC-D)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:S
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:LCSW, CADC-D
Other - Prefix:PROF
Other - First Name:DEBBIE
Other - Middle Name:JEAN
Other - Last Name:SUDTELGTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CICSW
Mailing Address - Street 1:17100 W. BLUEMOUND RD.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:262-894-1477
Mailing Address - Fax:
Practice Address - Street 1:17100 W BLUEMOUND RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5950
Practice Address - Country:US
Practice Address - Phone:262-894-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14427101YA0400X
WI2398-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical