Provider Demographics
NPI:1639349343
Name:OLSON, CATHERINE C (LICSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:OLSON
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 1:44 SAINT CROIX TRL S
Mailing Address - Street 2:#155
Mailing Address - City:LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55043-9664
Mailing Address - Country:US
Mailing Address - Phone:651-337-1341
Mailing Address - Fax:
Practice Address - Street 1:44 SAINT CROIX TRL S
Practice Address - Street 2:#155
Practice Address - City:LAKELAND
Practice Address - State:MN
Practice Address - Zip Code:55043-9664
Practice Address - Country:US
Practice Address - Phone:651-337-1341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN57613800Medicaid