Provider Demographics
NPI:1619256088
Name:OLSON, GWEN MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GWEN
Other - Middle Name:MARIE
Other - Last Name:SCHRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 EAST FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805
Mailing Address - Country:US
Mailing Address - Phone:218-728-4404
Mailing Address - Fax:218-728-4404
Practice Address - Street 1:4000 W 9TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-1563
Practice Address - Country:US
Practice Address - Phone:218-625-2685
Practice Address - Fax:218-625-2697
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2148106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist