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NPI Code Detail

MEDICARE: HEATHER ELIZABETH OLSEN LCSW

MEDICARE: HEATHER ELIZABETH OLSEN LCSW
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
11041C0700XClinical Social Worker7789708-3501UT

General Provider Information

NPI Number : 1649707076
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER ELIZABETH OLSEN LCSW
Provider Business Mailing Address
First Line : 1461 N 1600 E
Second Line :
City : LOGAN
State : UT
Zip : 84341-2940
Country : US
Telephone Number : 435-754-9554
Fax Number : 435-752-1095
Provider Business Practice Location Address
First Line : 186 E 1800 N
Second Line :
City : NORTH LOGAN
State : UT
Zip : 84341-2019
Country : US
Telephone Number : 435-754-9554
Fax Number : 435-752-1095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2017
Last Update Date : 05/16/2017

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Directions to “ HEATHER ELIZABETH OLSEN LCSW” Practice Location

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