Provider Demographics
NPI:1073078200
Name:LANE-OLSON, DEBRA A (LADC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:LANE-OLSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:CAVEGN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MHP, LADC
Mailing Address - Street 1:3870 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:FORT RIPLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56449-1500
Mailing Address - Country:US
Mailing Address - Phone:320-260-4184
Mailing Address - Fax:
Practice Address - Street 1:16405 HAVEN RD STE B
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-6400
Practice Address - Country:US
Practice Address - Phone:320-639-2193
Practice Address - Fax:320-639-2197
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304769101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)