Provider Demographics
NPI:1548384001
Name:HESTAND-OLSON, MICHELLE D
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:D
Last Name:HESTAND-OLSON
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 1:17012 PRESTWICK CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-7404
Mailing Address - Country:US
Mailing Address - Phone:405-401-0851
Mailing Address - Fax:
Practice Address - Street 1:17012 PRESTWICK CIR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-7404
Practice Address - Country:US
Practice Address - Phone:405-401-0851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)