Provider Demographics
NPI:1831135870
Name:OLSON, JENNIFER ANN (LICSW MSW MDIV)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:OLSON
Suffix:
Gender:
Credentials:LICSW MSW MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 6TH ST E APT 1103
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1976
Mailing Address - Country:US
Mailing Address - Phone:617-512-9813
Mailing Address - Fax:
Practice Address - Street 1:89 NEWBURY ST STE 101
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1098
Practice Address - Country:US
Practice Address - Phone:612-364-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23724Medicare ID - Type Unspecified