Provider Demographics
NPI:1982116224
Name:OLEAN, BRITT PROKOP (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BRITT
Middle Name:PROKOP
Last Name:OLEAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MS
Other - First Name:BRITT
Other - Middle Name:ELIZABETH
Other - Last Name:PROKOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:28767 BAY SHORE DR NW
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-5942
Mailing Address - Country:US
Mailing Address - Phone:218-259-4646
Mailing Address - Fax:
Practice Address - Street 1:28767 BAY SHORE DR NW
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-5942
Practice Address - Country:US
Practice Address - Phone:952-111-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN213221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21322OtherMINNESOTA BOARD OF SOCIAL WORK