Provider Demographics
NPI:1346909322
Name:OLOO, NICHOLAS O (LSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:O
Last Name:OLOO
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7819 146TH STREET CT E # NA
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6916
Mailing Address - Country:US
Mailing Address - Phone:302-357-1876
Mailing Address - Fax:
Practice Address - Street 1:7819 146TH STREET CT E # NA
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6916
Practice Address - Country:US
Practice Address - Phone:302-357-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ4-00102961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical