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NPI Code Detail

MEDICARE: DIANE OLSON LMSW

MEDICARE: DIANE OLSON LMSW
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
1104100000XSocial Worker6801067112MI

General Provider Information

NPI Number : 1649203563
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE OLSON LMSW
Provider Business Mailing Address
First Line : 28000 DEQUINDRE RD
Second Line :
City : WARREN
State : MI
Zip : 48092-2468
Country : US
Telephone Number : 586-753-0405
Fax Number : 586-753-0404
Provider Business Practice Location Address
First Line : 5111 AUTO CLUB DR
Second Line : #120
City : DEARBORN
State : MI
Zip : 48126-2749
Country : US
Telephone Number : 313-583-0735
Fax Number : 313-583-0751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 07/08/2007

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Directions to “ DIANE OLSON LMSW” Practice Location

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