Provider Demographics
NPI:1467984484
Name:OLSON, WENDY RUTH (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:RUTH
Last Name:OLSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 HILLCREST DR APT 10
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-5700
Mailing Address - Country:US
Mailing Address - Phone:320-232-5954
Mailing Address - Fax:
Practice Address - Street 1:520 5TH STREET NW
Practice Address - Street 2:NORTHERN PINES MENTAL HEALTH
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-5700
Practice Address - Country:US
Practice Address - Phone:218-829-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN215351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical