Provider Demographics
NPI:1629772652
Name:OLSEN, TRISHA ANN (NONE)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:ANN
Last Name:OLSEN
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:ANN
Other - Last Name:KUKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:7760 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5800
Mailing Address - Country:US
Mailing Address - Phone:612-594-8405
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:7760 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55435-5800
Practice Address - Country:US
Practice Address - Phone:612-594-8405
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician