Provider Demographics
NPI:1417252958
Name:OLSON, HEDI MARIE (SUDP-T)
Entity Type:Individual
Prefix:
First Name:HEDI
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:SUDP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 E PRATT AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-5360
Mailing Address - Country:US
Mailing Address - Phone:509-251-7247
Mailing Address - Fax:
Practice Address - Street 1:4324 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1209
Practice Address - Country:US
Practice Address - Phone:509-251-7247
Practice Address - Fax:509-327-7816
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60090682225700000X
WACO61062317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist