1487987269 NPI number — DR. KAREN ANN OLSON PH.D.

Table of content: DR. KAREN ANN OLSON PH.D. (NPI 1487987269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487987269 NPI number — DR. KAREN ANN OLSON PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON
Provider First Name:
KAREN
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLSON
Provider Other First Name:
KAREN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487987269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
823 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRON MOUNTAIN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49801-2011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-221-0856
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 E LUDINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRON MOUNTAIN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49801-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-239-9918
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6301006240 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 82-4463331 . This is a "ST CHARLES PSYCHOTHERAPY SERVICES, PLLC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".