Provider Demographics
NPI:1669166955
Name:OLSON, OLIVIA GALE (LGSW)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GALE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 PORTLAND AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6839
Mailing Address - Country:US
Mailing Address - Phone:612-718-4859
Mailing Address - Fax:
Practice Address - Street 1:15060 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-9457
Practice Address - Country:US
Practice Address - Phone:612-718-4859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31059104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker