Provider Demographics
NPI:1518092139
Name:OLSEN, LINDA MAY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MAY
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2424
Mailing Address - Country:US
Mailing Address - Phone:651-645-2042
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W
Practice Address - Street 2:SUITE NUMBER N464
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2801
Practice Address - Country:US
Practice Address - Phone:651-294-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical