Provider Demographics
NPI:1467552513
Name:OLSON, ELAINE K (LCPC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:K
Last Name:OLSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 NAPLES CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-3510
Mailing Address - Country:US
Mailing Address - Phone:217-722-7295
Mailing Address - Fax:
Practice Address - Street 1:2303 NAPLES CT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-3510
Practice Address - Country:US
Practice Address - Phone:217-722-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009774101YP2500X
WI1111101YP2500X
WI33291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical