Provider Demographics
NPI:1154517571
Name:OLSON, MELANIE S (LICSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:S
Last Name:OLSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4756 MUNGER SHAW RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MN
Mailing Address - Zip Code:55779-9509
Mailing Address - Country:US
Mailing Address - Phone:218-340-7884
Mailing Address - Fax:
Practice Address - Street 1:4756 MUNGER SHAW RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MN
Practice Address - Zip Code:55779-9509
Practice Address - Country:US
Practice Address - Phone:218-340-7884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN131061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical