Provider Demographics
NPI:1962692764
Name:OLSSON, SASHA (LCSW)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:OLSSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3949 SOUTH 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603
Mailing Address - Country:US
Mailing Address - Phone:541-882-1487
Mailing Address - Fax:541-851-3983
Practice Address - Street 1:6000 NEW WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-9382
Practice Address - Country:US
Practice Address - Phone:541-884-1841
Practice Address - Fax:907-729-4235
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL80601041C0700X
AK7831041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK8EE639Medicare PIN
AK8EL976Medicare PIN
AK8EL977Medicare PIN
AK8EL978Medicare PIN
AK8EL979Medicare PIN