Provider Demographics
NPI:1063041051
Name:OLSON, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RED RIVER AVE S
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-2538
Mailing Address - Country:US
Mailing Address - Phone:612-816-1983
Mailing Address - Fax:320-686-0170
Practice Address - Street 1:101 RED RIVER AVE S
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-2538
Practice Address - Country:US
Practice Address - Phone:612-816-1983
Practice Address - Fax:320-686-0170
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty