Provider Demographics
NPI:1376728634
Name:OLSON, ALICE ANN
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ANN
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 1:66 E 3RD ST
Mailing Address - Street 2:201
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3478
Mailing Address - Country:US
Mailing Address - Phone:507-452-7292
Mailing Address - Fax:507-457-9887
Practice Address - Street 1:1321 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1156
Practice Address - Country:US
Practice Address - Phone:608-637-7052
Practice Address - Fax:608-637-8500
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6458-120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health