Individual
MICA OLLILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
3817 S VIRGINIA PL, SPRINGFIELD, MO 65807-5270
(417) 527-0618
Mailing address
3817 S VIRGINIA PL, SPRINGFIELD, MO 65807-5270
(417) 527-0618
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2019036740
MO
1041C0700X
Clinical Social Worker
34008420A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14416451
CAQH
—
05
—
490075538
—
MO
Enumeration date
06/07/2016
Last updated
07/05/2022
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