Healthcare Provider Details

I. General information

NPI: 1952401101
Provider Name (Legal Business Name): MARJORIE ELYN OLSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 PARKHURST DR
WHITE LAKE MI
48386-3392
US

IV. Provider business mailing address

609 PARKHURST DR
WHITE LAKE MI
48386-3392
US

V. Phone/Fax

Practice location:
  • Phone: 248-698-3408
  • Fax: 248-698-3405
Mailing address:
  • Phone: 248-698-3408
  • Fax: 248-698-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801080566
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: