Provider Demographics
NPI:1578722864
Name:OLSON, JESSICA ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ELIZABETH
Last Name: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 1:7 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1505
Mailing Address - Country:US
Mailing Address - Phone:508-615-9633
Mailing Address - Fax:
Practice Address - Street 1:7 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1026
Practice Address - Country:US
Practice Address - Phone:508-615-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103T00000X103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist