MEDICARE: KELLY ANN OLSEN LMSW

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

General Provider Information

NPI Number	:	1699964312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN OLSEN LMSW

Provider Business Mailing Address
First Line	:	2340 FAIRVIEW BLVD STE 100
Second Line	:
City	:	FAIRVIEW
State	:	TN
Zip	:	37062-9458
Country	:	US
Telephone Number	:	629-205-3018
Fax Number	:	629-205-3020

Provider Business Practice Location Address
First Line	:	2340 FAIRVIEW BLVD STE 100
Second Line	:
City	:	FAIRVIEW
State	:	TN
Zip	:	37062-9458
Country	:	US
Telephone Number	:	629-205-3018
Fax Number	:	629-205-3020

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	07/23/2024

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Directions to “ KELLY ANN OLSEN LMSW” Practice Location

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