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NPI Code Detail

MEDICARE: DEREK OLSEN

MEDICARE:   DEREK  OLSEN
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 WorkerPCSW-1281WY

General Provider Information

NPI Number : 1891552709
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK OLSEN
Provider Business Mailing Address
First Line : 3322 STRAHAN PKWY
Second Line :
City : SHERIDAN
State : WY
Zip : 82801-9162
Country : US
Telephone Number : 619-683-3100
Fax Number : 307-672-2044
Provider Business Practice Location Address
First Line : 3322 STRAHAN PKWY
Second Line :
City : SHERIDAN
State : WY
Zip : 82801-9162
Country : US
Telephone Number : 307-672-2044
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2024
Last Update Date : 12/09/2025

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