Healthcare Provider Details

I. General information

NPI: 1215643176
Provider Name (Legal Business Name): KIMBERLY A OLMSTED LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY HOAGLIN LMSW

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E MAUMEE ST STE 3
ADRIAN MI
49221-2735
US

IV. Provider business mailing address

906 OAK BROOK DR
JACKSON MI
49203-2672
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-5810
  • Fax:
Mailing address:
  • Phone: 517-392-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801093180
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093180
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: