Provider Demographics
NPI:1861464729
Name:OLLSWANG, LYNN M (ACSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:M
Last Name:OLLSWANG
Suffix:
Gender:F
Credentials:ACSW LCSW
Other - Prefix:MISS
Other - First Name:MERELYN
Other - Middle Name:L
Other - Last Name:MANEGOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2524 E. WEBSTER PL.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4253
Mailing Address - Country:US
Mailing Address - Phone:414-964-9200
Mailing Address - Fax:414-964-4816
Practice Address - Street 1:2524 E. WEBSTER PLACE
Practice Address - Street 2:SUITE 203
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4253
Practice Address - Country:US
Practice Address - Phone:414-964-9200
Practice Address - Fax:414-964-4816
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13531231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39656400Medicaid
WI084452005Medicare ID - Type Unspecified