Provider Demographics
NPI:1386337855
Name:OLSON, MEGAN JO (LMSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JO
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3659 S CREEKWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6072
Mailing Address - Country:US
Mailing Address - Phone:208-484-1183
Mailing Address - Fax:
Practice Address - Street 1:1224 1ST ST S STE 302
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3963
Practice Address - Country:US
Practice Address - Phone:208-502-0183
Practice Address - Fax:208-932-9693
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID43635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker