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General NPI Number Information
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NPI Number | 1891552709
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Entity Type | Individual
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Provider Name | DEREK OLSEN
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Gender | Male
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 3322 STRAHAN PKWY
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City | SHERIDAN
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State | WY
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Zip | 82801-9162
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Country | US
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Telephone | 307-672-2044
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Fax |
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Provider Business Mailing Address
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Address Line | 3322 STRAHAN PKWY
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City | SHERIDAN
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State | WY
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Zip | 82801-9162
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Country | US
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Telephone | 619-683-3100
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Fax | 307-672-2044
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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-1281
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License Number State | WY
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