Healthcare Provider Details

I. General information

NPI: 1710753579
Provider Name (Legal Business Name): REBEKKAH OLSON MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 PARK GLEN RD STE 155
ST LOUIS PARK MN
55416-4888
US

IV. Provider business mailing address

4500 PARK GLEN RD STE 155
ST LOUIS PARK MN
55416-4888
US

V. Phone/Fax

Practice location:
  • Phone: 612-470-5327
  • Fax: 888-975-8939
Mailing address:
  • Phone: 612-470-5327
  • Fax: 888-975-8939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29108
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: