Provider Demographics
NPI:1952520892
Name:OLSSON, COLEEN III (LCSW)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:OLSSON
Suffix:III
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 1:99 AUTUMN ST
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1301
Mailing Address - Country:US
Mailing Address - Phone:724-857-3570
Mailing Address - Fax:724-375-5756
Practice Address - Street 1:99 AUTUMN ST
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-1301
Practice Address - Country:US
Practice Address - Phone:724-857-3570
Practice Address - Fax:724-375-5756
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0166681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA257515RN0Medicare PIN