Individual
MR. OLYVER JARRETT BLAKEWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5000 W NATIONAL AVE, MILWAUKEE, WI 53295
(414) 384-2000
Mailing address
5000 W NATIONAL AVE RM 3100, MILWAUKEE, WI 53295-0001
(414) 384-2000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCSW66048
CA
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
LCSW66048
CA
Other
Enumeration date
05/01/2013
Last updated
12/13/2021
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