Provider Demographics
NPI:1639435415
Name:OLSON, WILLIAM CHARLES (BS, LADC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES
Last Name:OLSON
Suffix:
Gender:M
Credentials:BS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WASHINGTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3351
Mailing Address - Country:US
Mailing Address - Phone:612-454-2453
Mailing Address - Fax:
Practice Address - Street 1:15 WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3351
Practice Address - Country:US
Practice Address - Phone:612-454-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303140101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)