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NPI Code Detail

MEDICARE: JESSICA MAE MATHWIG-OLSON LICSW

MEDICARE: JESSICA MAE MATHWIG-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
11041C0700XClinical Social Worker17292MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1822524000OTHERMNMAGELLEN
2456G7MAOTHERMNBCBS
3HP56139OTHERMNHEALTH PARTNERS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720169469
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MAE MATHWIG-OLSON LICSW
Provider Business Mailing Address
First Line : 1100 GLENWOOD AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-1430
Country : US
Telephone Number : 612-871-1454
Fax Number :
Provider Business Practice Location Address
First Line : 1100 GLENWOOD AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-1430
Country : US
Telephone Number : 612-871-1454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 05/02/2023

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Directions to “ JESSICA MAE MATHWIG-OLSON LICSW” Practice Location

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