=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033869722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA OLSON LMSW-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2022
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1851 WAGON WHEEL LN
-----------------------------------------------------
City | NEGAUNEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49866-9731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-250-0484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1851 WAGON WHEEL LN
-----------------------------------------------------
City | NEGAUNEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49866-9731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-250-0484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6801118307
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------