MEDICARE: MRS. LAUREN ELIZABETH OLSON L.C.S.W

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	149.071399	IL

General Provider Information

NPI Number	:	1326412511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN ELIZABETH OLSON L.C.S.W

Provider Business Mailing Address
First Line	:	1958 W FOSTER AVE
Second Line	:	UNIT 2W
City	:	CHICAGO
State	:	IL
Zip	:	60640-1199
Country	:	US
Telephone Number	:	708-638-8303
Fax Number	:

Provider Business Practice Location Address
First Line	:	1958 W FOSTER AVE
Second Line	:	UNIT 2W
City	:	CHICAGO
State	:	IL
Zip	:	60640-1199
Country	:	US
Telephone Number	:	708-638-8303
Fax Number	:

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

Provider Enumeration Date	:	11/25/2015
Last Update Date	:	11/25/2015

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