MEDICARE: TRACY LEE OLSON MSW

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	104100000X	Social Worker	3565	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548362221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY LEE OLSON MSW

Provider Business Mailing Address
First Line	:	601 E 3RD ST
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-4512
Country	:	US
Telephone Number	:	715-384-0080
Fax Number	:	715-384-0090

Provider Business Practice Location Address
First Line	:	601 E 3RD ST
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-4512
Country	:	US
Telephone Number	:	715-384-0080
Fax Number	:	715-384-0090

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	03/28/2014

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