Provider Demographics
NPI:1174227367
Name:OLSON, CHERYL L
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:CULVER
Mailing Address - State:OR
Mailing Address - Zip Code:97734-0287
Mailing Address - Country:US
Mailing Address - Phone:541-325-9272
Mailing Address - Fax:
Practice Address - Street 1:518 E RIDEVIEW DR
Practice Address - Street 2:
Practice Address - City:CULVER
Practice Address - State:OR
Practice Address - Zip Code:97734
Practice Address - Country:US
Practice Address - Phone:541-325-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical