Provider Demographics
NPI:1467892786
Name:OLSON, ANTOINETTE LEIGH (LMSW)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:LEIGH
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 UNIVERSITY AVE
Mailing Address - Street 2:120
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2343
Mailing Address - Country:US
Mailing Address - Phone:515-248-1500
Mailing Address - Fax:515-248-1510
Practice Address - Street 1:1200 UNIVERSITY AVE
Practice Address - Street 2:120
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2343
Practice Address - Country:US
Practice Address - Phone:515-248-1500
Practice Address - Fax:515-248-1510
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008209104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker