Provider Demographics
NPI:1982891677
Name:OLSON, ADELIA BERNICE (LISW)
Entity Type:Individual
Prefix:
First Name:ADELIA
Middle Name:BERNICE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 FRIDAY LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2302
Mailing Address - Country:US
Mailing Address - Phone:419-529-4291
Mailing Address - Fax:419-529-4291
Practice Address - Street 1:1620 FRIDAY LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2302
Practice Address - Country:US
Practice Address - Phone:419-529-4291
Practice Address - Fax:419-529-4291
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00081621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical