Provider Demographics
NPI:1669484705
Name:O'LEARY, COLLEEN (MS, LP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 STONY POINT RD
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:MN
Mailing Address - Zip Code:56021-9738
Mailing Address - Country:US
Mailing Address - Phone:507-359-5439
Mailing Address - Fax:
Practice Address - Street 1:122 STONY POINT RD
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:MN
Practice Address - Zip Code:56021-9738
Practice Address - Country:US
Practice Address - Phone:507-359-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2982103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist