Provider Demographics
NPI:1730869645
Name:OELLERICH, KATELYN
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:OELLERICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5972 STATE ROAD 39
Mailing Address - Street 2:
Mailing Address - City:MINERAL POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53565-9079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 E BUSINESS HIGHWAY 151 STE D
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3875
Practice Address - Country:US
Practice Address - Phone:608-470-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7749226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health