Provider Demographics
NPI:1023503430
Name:OLSON-ENGEBRETH, NANCY JANE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JANE
Last Name:OLSON-ENGEBRETH
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 PARK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5427
Mailing Address - Country:US
Mailing Address - Phone:612-925-6033
Mailing Address - Fax:612-925-8496
Practice Address - Street 1:2501 HANLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8786
Practice Address - Country:US
Practice Address - Phone:715-954-5300
Practice Address - Fax:715-954-5301
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131138-121104100000X
MN26094104100000X, 1041C0700X
WI9422-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker