=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831135870
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER ANN OLSON LICSW MSW MDIV
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2006
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 89 NEWBURY ST STE 101
-----------------------------------------------------
City | DANVERS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01923-1098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-364-1428
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 172 6TH ST E APT 1103
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55101-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-512-9813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 113039
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------