Provider Demographics
NPI:1407994536
Name:OLSEN, JENNIFER LINDSEY (CADC,)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LINDSEY
Last Name:OLSEN
Suffix:
Gender:F
Credentials:CADC,
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LINDSEY
Other - Last Name:GUENTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1802 N PINE ST APT J200
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-4477
Mailing Address - Country:US
Mailing Address - Phone:503-570-6559
Mailing Address - Fax:
Practice Address - Street 1:24499 SW GRAHAMS FERRY RD
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7523
Practice Address - Country:US
Practice Address - Phone:503-570-6559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OR06-07-35101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)