Provider Demographics
NPI:1568086536
Name:OLSON, LARS (MS)
Entity Type:Individual
Prefix:MR
First Name:LARS
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-2828
Mailing Address - Country:US
Mailing Address - Phone:307-254-1196
Mailing Address - Fax:
Practice Address - Street 1:1650 MADISON AVE STE 102
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5471
Practice Address - Country:US
Practice Address - Phone:507-345-7012
Practice Address - Fax:507-388-6937
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician