MEDICARE: KENDRA M OLSON LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	15703	MN
2	104100000X	Social Worker	15703	MN

General Provider Information

NPI Number	:	1194030932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA M OLSON LICSW

Provider Business Mailing Address
First Line	:	8170 33RD AVE S # MS 21110Q
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 PARK NICOLLET BLVD
Second Line	:	3RD FLOOR NORTH, MENTAL HEALTH
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2527
Country	:	US
Telephone Number	:	952-993-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	03/09/2021

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