Healthcare Provider Details

I. General information

NPI: 1285772657
Provider Name (Legal Business Name): DAVID NEIL OLSON MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 HALLQUIST AVE
RED WING MN
55066-3957
US

IV. Provider business mailing address

2285 HALLQUIST AVE
RED WING MN
55066-3957
US

V. Phone/Fax

Practice location:
  • Phone: 651-764-4747
  • Fax:
Mailing address:
  • Phone: 651-764-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number260873
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5112
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: