Provider Demographics
NPI:1861163206
Name:OLSON, SHAYNE MARIE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:SHAYNE
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:SHAYNE
Other - Middle Name:MARIE
Other - Last Name:OLHEISER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:2100 CAMPUS DR SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4831
Mailing Address - Country:US
Mailing Address - Phone:507-328-6680
Mailing Address - Fax:
Practice Address - Street 1:2100 CAMPUS DR SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4831
Practice Address - Country:US
Practice Address - Phone:150-732-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN146941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical