Healthcare Provider Details

I. General information

NPI: 1457596264
Provider Name (Legal Business Name): LAURA LEANNE OLSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SW HIGHWAY 97 STE 101
MADRAS OR
97741-9247
US

IV. Provider business mailing address

375 NW BEAVER ST SUITE 101
PRINEVILLE OR
97754-1802
US

V. Phone/Fax

Practice location:
  • Phone: 541-475-7800
  • Fax:
Mailing address:
  • Phone: 541-447-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: