Healthcare Provider Details

I. General information

NPI: 1093357402
Provider Name (Legal Business Name): SHAWNA MAY OLSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 BRESLAUER WAY
REDDING CA
96001-4246
US

IV. Provider business mailing address

4975 CEDARS RD
REDDING CA
96001-4110
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-5252
  • Fax:
Mailing address:
  • Phone: 530-917-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116003
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: