Provider Demographics
NPI:1881618940
Name:OLSON, ALTHEA R (LCSW)
Entity type:Individual
Prefix:
First Name:ALTHEA
Middle Name:R
Last Name:OLSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15724 S ROUTE 59 STE 102
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2806
Mailing Address - Country:US
Mailing Address - Phone:630-527-8877
Mailing Address - Fax:815-725-8877
Practice Address - Street 1:15724 S ROUTE 59 STE 102
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2806
Practice Address - Country:US
Practice Address - Phone:630-527-8877
Practice Address - Fax:630-527-8877
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490084461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR00712Medicare PIN
IL211727Medicare PIN