Provider Demographics
NPI:1467091736
Name:OLSON, TIFFANY KAY (LCSW, CSAC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:KAY
Last Name:OLSON
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30926 OLSON LN
Mailing Address - Street 2:
Mailing Address - City:LONE ROCK
Mailing Address - State:WI
Mailing Address - Zip Code:53556-9009
Mailing Address - Country:US
Mailing Address - Phone:608-604-9199
Mailing Address - Fax:
Practice Address - Street 1:30955 COUNTY HWY TB
Practice Address - Street 2:
Practice Address - City:LONE ROCK
Practice Address - State:WI
Practice Address - Zip Code:53556-9021
Practice Address - Country:US
Practice Address - Phone:608-604-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16571-132101YA0400X
WI11345-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)