MEDICARE: LAURA OLSON SWANSON-WALLACE LCSW

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
1	1041C0700X	Clinical Social Worker	104332	CA
2	106S00000X	Behavior Technician
3	1041C0700X	Clinical Social Worker	128753	CA

General Provider Information

NPI Number	:	1720559115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA OLSON SWANSON-WALLACE LCSW

Provider Business Mailing Address
First Line	:	1482 E 1ST AVE
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-1547
Country	:	US
Telephone Number	:	831-818-8072
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 SAINT GEORGE LN STE 8
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-1310
Country	:	US
Telephone Number	:	831-818-8072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	11/12/2025

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