Healthcare Provider Details

I. General information

NPI: 1700516838
Provider Name (Legal Business Name): MARK SCOTT OLSON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 N MAIN ST
CEDAR SPRINGS MI
49319-8041
US

IV. Provider business mailing address

261 N MAIN ST
CEDAR SPRINGS MI
49319-8041
US

V. Phone/Fax

Practice location:
  • Phone: 616-287-5637
  • Fax:
Mailing address:
  • Phone: 616-287-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119807
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: