Provider Demographics
NPI:1699875971
Name:OLSON, PATRICIA ANN (LICSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
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 1:205 W 2ND ST STE 431
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1922
Mailing Address - Country:US
Mailing Address - Phone:218-310-8712
Mailing Address - Fax:218-216-1226
Practice Address - Street 1:205 W 2ND ST STE 431
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1922
Practice Address - Country:US
Practice Address - Phone:218-310-8712
Practice Address - Fax:218-216-1226
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4302287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39779500Medicaid
MN580613500Medicaid
WIP02325Medicare UPIN
WI39779500Medicaid