Provider Demographics
NPI:1861534067
Name:OLIVER, LYNN SHELDON (LICSW)
Entity type:Individual
Prefix:MR
First Name:LYNN
Middle Name:SHELDON
Last Name:OLIVER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14749 SNAKE TRL
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-4624
Mailing Address - Country:US
Mailing Address - Phone:507-835-3366
Mailing Address - Fax:
Practice Address - Street 1:710 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3810
Practice Address - Country:US
Practice Address - Phone:507-625-7660
Practice Address - Fax:507-625-8998
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional