Provider Demographics
NPI:1629590823
Name:OLSON, ANN MARIE (LADC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4002
Mailing Address - Country:US
Mailing Address - Phone:218-888-8032
Mailing Address - Fax:
Practice Address - Street 1:112 1ST ST W
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4002
Practice Address - Country:US
Practice Address - Phone:218-888-8032
Practice Address - Fax:218-888-8033
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302868101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)