Healthcare Provider Details

I. General information

NPI: 1346909322
Provider Name (Legal Business Name): NICHOLAS O OLOO LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7819 146TH STREET CT E # NA
PUYALLUP WA
98375-6916
US

IV. Provider business mailing address

7819 146TH STREET CT E # NA
PUYALLUP WA
98375-6916
US

V. Phone/Fax

Practice location:
  • Phone: 302-357-1876
  • Fax:
Mailing address:
  • Phone: 302-357-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ4-0010296
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: