Healthcare Provider Details

I. General information

NPI: 1477687077
Provider Name (Legal Business Name): EDWARD WILLIAM OLPIN ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 12/19/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 GEER RD
TURLOCK CA
95380-3311
US

IV. Provider business mailing address

875 GEER RD
TURLOCK CA
95380-3311
US

V. Phone/Fax

Practice location:
  • Phone: 209-633-3057
  • Fax: 209-468-3516
Mailing address:
  • Phone: 209-633-3057
  • Fax: 209-468-3516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: