Individual
OLIVIA RUTH BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
103 S GIBSON ST, MEDFORD, WI 54451-1622
(715) 748-8112
Mailing address
103 S GIBSON ST, MEDFORD, WI 54451-1622
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8852226
WI
Other
Enumeration date
04/10/2026
Last updated
04/10/2026
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