Healthcare Provider Details

I. General information

NPI: 1386094407
Provider Name (Legal Business Name): JESSICA OLSTAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8719 S 113TH ST APT 101
SEATTLE WA
98178-3300
US

IV. Provider business mailing address

8719 S 113TH ST APT 101
SEATTLE WA
98178-3300
US

V. Phone/Fax

Practice location:
  • Phone: 206-556-7610
  • Fax:
Mailing address:
  • Phone: 206-556-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61349551
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCO60275619
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: