Provider Demographics
NPI:1053321208
Name:OLSON, DOUGLAS HUNTINGTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HUNTINGTON
Last Name:OLSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 W NOKOMIS PKWY
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1848
Mailing Address - Country:US
Mailing Address - Phone:612-722-0863
Mailing Address - Fax:
Practice Address - Street 1:ONE VETERANS DRIVE
Practice Address - Street 2:116B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417
Practice Address - Country:US
Practice Address - Phone:612-725-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0747103TC0700X
WI1505-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical