Healthcare Provider Details

I. General information

NPI: 1033869722
Provider Name (Legal Business Name): JESSICA OLSON LMSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LECLAIR LBSW

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 WAGON WHEEL LN
NEGAUNEE MI
49866-9731
US

IV. Provider business mailing address

1851 WAGON WHEEL LN
NEGAUNEE MI
49866-9731
US

V. Phone/Fax

Practice location:
  • Phone: 906-250-0484
  • Fax:
Mailing address:
  • Phone: 906-250-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801118307
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: