Provider Demographics
NPI:1033869722
Name:OLSON, JESSICA (LBSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:LECLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:205 SEILO AVE
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-2911
Mailing Address - Country:US
Mailing Address - Phone:906-250-0484
Mailing Address - Fax:
Practice Address - Street 1:205 SEILO AVE
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-2911
Practice Address - Country:US
Practice Address - Phone:906-250-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085602104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker