Provider Demographics
NPI:1275912313
Name:OLSON, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
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 1:8000 RIVER POINTE DR
Mailing Address - Street 2:APT 2B33
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-8099
Mailing Address - Country:US
Mailing Address - Phone:708-712-5746
Mailing Address - Fax:
Practice Address - Street 1:8000 RIVER POINTE DR
Practice Address - Street 2:APT 2B33
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-8099
Practice Address - Country:US
Practice Address - Phone:708-712-5746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1876152471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography