Healthcare Provider Details

I. General information

NPI: 1215601083
Provider Name (Legal Business Name): KARLIE OLSON CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2297 KANSAS AVE SE STE 5
HURON SD
57350-4287
US

IV. Provider business mailing address

2297 KANSAS AVE SE STE 5
HURON SD
57350-4287
US

V. Phone/Fax

Practice location:
  • Phone: 605-941-1509
  • Fax: 605-205-8962
Mailing address:
  • Phone: 605-941-1509
  • Fax: 605-205-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6043
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6043
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerBOARD OF SOCIAL WORK EXAMINERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: