Healthcare Provider Details

I. General information

NPI: 1518060433
Provider Name (Legal Business Name): MARCIE DENISE OLSON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12607 SE MILL PLAIN BLVD CASCADE PARK MEDICAL OFFICE
VANCOUVER WA
98684-6055
US

IV. Provider business mailing address

620 H ST
COLUMBIA CITY OR
97018-8711
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-4460
  • Fax:
Mailing address:
  • Phone: 503-442-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberOR 001676
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberWA LW00006529
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: