Provider Demographics
NPI:1710034541
Name:OLSON, JESSICA RANEE (CSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RANEE
Last Name:OLSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 E 100 S
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4742
Mailing Address - Country:US
Mailing Address - Phone:435-753-3612
Mailing Address - Fax:
Practice Address - Street 1:536 E 100 S
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4742
Practice Address - Country:US
Practice Address - Phone:435-753-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT378453-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker