Provider Demographics
NPI:1073907465
Name:OLSON, SARAH E
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:E
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 1:6930 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1826
Mailing Address - Country:US
Mailing Address - Phone:907-306-8776
Mailing Address - Fax:907-677-5989
Practice Address - Street 1:6930 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1826
Practice Address - Country:US
Practice Address - Phone:907-306-8776
Practice Address - Fax:907-677-5989
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNPI1316151095171M00000X
AKNPI1740863265171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNPI1740863265Medicaid
AKNPI1316151095Medicaid