Healthcare Provider Details

I. General information

NPI: 1174908636
Provider Name (Legal Business Name): KATIE OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 NW 6TH ST
GAINESVILLE FL
32601-4020
US

IV. Provider business mailing address

2248 HERITAGE DR NE
ATLANTA GA
30345-3535
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-4411
  • Fax:
Mailing address:
  • Phone: 352-538-3017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09931799
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW24523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: