Provider Demographics
NPI:1073677076
Name:OLSON, MARY KATHRYN (MSW, LCSW, CACIII)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:OLSON
Suffix:
Gender:F
Credentials:MSW, LCSW, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BOULDER CRESCENT ST STE 101C
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3344
Mailing Address - Country:US
Mailing Address - Phone:719-570-9415
Mailing Address - Fax:719-637-2539
Practice Address - Street 1:10 BOULDER CRESCENT ST STE 101C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3344
Practice Address - Country:US
Practice Address - Phone:719-570-9415
Practice Address - Fax:719-637-2539
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9921111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical