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General NPI Number Information
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NPI Number | 1255007761
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Entity Type | Individual
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Provider Name | LACI ROSE OLSON PCSW-1184
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Gender | Female
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 14 GREAT PLAINS RD
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City | ARAPAHOE
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State | WY
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Zip | 82510-9144
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Country | US
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Telephone | 307-856-9281
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Fax |
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Provider Business Mailing Address
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Address Line | 120 N 6TH ST E
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City | RIVERTON
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State | WY
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Zip | 82501-4405
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Country | US
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Telephone | 307-856-9281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PCSW-1184
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License Number State | WY
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