Provider Demographics
NPI:1457596264
Name:OLSON, LAURA LEANNE (MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEANNE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 NW BEAVER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1802
Mailing Address - Country:US
Mailing Address - Phone:541-447-0707
Mailing Address - Fax:
Practice Address - Street 1:910 SW HIGHWAY 97
Practice Address - Street 2:STE 101
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9247
Practice Address - Country:US
Practice Address - Phone:541-475-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500663536Medicaid
ORR179732Medicare PIN