Provider Demographics
NPI:1255720496
Name:JEWETT, OLIVIA INGALLS (MS, LMFT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:INGALLS
Last Name:JEWETT
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 INTERLACHEN BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1321
Mailing Address - Country:US
Mailing Address - Phone:320-492-3298
Mailing Address - Fax:
Practice Address - Street 1:5200 WILLSON RD STE 450
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1396
Practice Address - Country:US
Practice Address - Phone:320-492-3298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3381106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist