Provider Demographics
NPI:1497431324
Name:OLVERSON, LAJESSICA
Entity Type:Individual
Prefix:
First Name:LAJESSICA
Middle Name:
Last Name:OLVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833
Mailing Address - Country:US
Mailing Address - Phone:419-685-8010
Mailing Address - Fax:419-932-6232
Practice Address - Street 1:11590 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246
Practice Address - Country:US
Practice Address - Phone:513-771-7239
Practice Address - Fax:513-771-3878
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator