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NPI Code Detail

MEDICARE: MS. LACI ROSE OLSON PCSW-1184

MEDICARE: MS. LACI ROSE OLSON PCSW-1184
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerPCSW-1184WY

General Provider Information

NPI Number : 1255007761
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LACI ROSE OLSON PCSW-1184
Provider Business Mailing Address
First Line : 120 N 6TH ST E
Second Line :
City : RIVERTON
State : WY
Zip : 82501-4405
Country : US
Telephone Number : 307-856-9281
Fax Number :
Provider Business Practice Location Address
First Line : 14 GREAT PLAINS RD
Second Line :
City : ARAPAHOE
State : WY
Zip : 82510-9144
Country : US
Telephone Number : 307-856-9281
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2021
Last Update Date : 08/13/2024

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