Provider Demographics
NPI:1467941476
Name:OLSON, MEGAN (RBT-18-47986)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:RBT-18-47986
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33862 N SHAWNEE AVE
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2874
Mailing Address - Country:US
Mailing Address - Phone:847-915-8272
Mailing Address - Fax:
Practice Address - Street 1:33862 N SHAWNEE AVE
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2874
Practice Address - Country:US
Practice Address - Phone:847-915-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18-47986106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician