Provider Demographics
NPI:1063718815
Name:PAMELA PHILLIPS OLSON, MSW LTD
Entity type:Organization
Organization Name:PAMELA PHILLIPS OLSON, MSW LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:608-233-7431
Mailing Address - Street 1:18549 COUNTY HWY A
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-8662
Mailing Address - Country:US
Mailing Address - Phone:608-647-8220
Mailing Address - Fax:608-647-8162
Practice Address - Street 1:715 HILL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3576
Practice Address - Country:US
Practice Address - Phone:608-233-7431
Practice Address - Fax:608-647-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2122123261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)