Healthcare Provider Details

I. General information

NPI: 1790067452
Provider Name (Legal Business Name): EMILY BETH OLSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY BETH OSWALT

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 PARK CENTRAL SQ SUITE 220
SPRINGFIELD MO
65806-1339
US

IV. Provider business mailing address

134 PARK CENTRAL SQ SUITE 220
SPRINGFIELD MO
65806-1339
US

V. Phone/Fax

Practice location:
  • Phone: 844-536-8266
  • Fax:
Mailing address:
  • Phone: 844-536-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2011014775
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: