Provider Demographics
NPI:1427377514
Name:OLSON, CALLEEN M (DIPLOM, LAC, LMT)
Entity Type:Individual
Prefix:
First Name:CALLEEN
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:DIPLOM, LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 N ROUNDUP RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8441
Mailing Address - Country:US
Mailing Address - Phone:303-841-7263
Mailing Address - Fax:303-841-7263
Practice Address - Street 1:10841 S CROSSROADS DR STE 107
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9089
Practice Address - Country:US
Practice Address - Phone:303-841-7263
Practice Address - Fax:303-841-7263
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1269171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO722772OtherOPTUM HEALTH CARE PROVIDER