Provider Demographics
NPI:1740828573
Name:OLSON, JESSICA MARIE (MSW,LICSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:BONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW,LICSW
Mailing Address - Street 1:2864 MIDDLE STREET
Mailing Address - Street 2:STE 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117
Mailing Address - Country:US
Mailing Address - Phone:651-439-2446
Mailing Address - Fax:651-439-2071
Practice Address - Street 1:2864 MIDDLE STREET
Practice Address - Street 2:STE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117
Practice Address - Country:US
Practice Address - Phone:651-439-2055
Practice Address - Fax:651-564-7613
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN244851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty