Provider Demographics
NPI:1518207844
Name:OLSON, TINA ANN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:ANN
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 1:825 SOUTH FRONT STREET P.O. BOX 3032
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-3032
Mailing Address - Country:US
Mailing Address - Phone:507-344-3360
Mailing Address - Fax:507-344-3370
Practice Address - Street 1:521 PFAU ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7032
Practice Address - Country:US
Practice Address - Phone:507-344-0621
Practice Address - Fax:507-344-2153
Is Sole Proprietor?:No
Enumeration Date:2013-02-23
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN157801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical