Healthcare Provider Details

I. General information

NPI: 1427256452
Provider Name (Legal Business Name): ASHLEY M OLSEN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 FAIRMONT BLVD
RAPID CITY SD
57701-7375
US

IV. Provider business mailing address

353 FAIRMONT BLVD
RAPID CITY SD
57701-7375
US

V. Phone/Fax

Practice location:
  • Phone: 605-755-1000
  • Fax:
Mailing address:
  • Phone: 605-755-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2236
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number870
License Number StateMT

VII. Legacy identifiers

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

# 1
Identifier6571470
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 2
Identifier4993047
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerWELLMARK
# 3
Identifier9234333
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerDAKOTACARE
# 4
Identifier2236
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerSD LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: