Provider Demographics
NPI:1710635438
Name:OLSEN, ANDREW RAYMOND (SUDP)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RAYMOND
Last Name:OLSEN
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5307
Mailing Address - Country:US
Mailing Address - Phone:425-757-9081
Mailing Address - Fax:509-325-4580
Practice Address - Street 1:220 11TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5307
Practice Address - Country:US
Practice Address - Phone:425-757-9081
Practice Address - Fax:509-325-4580
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61200273101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP61200273OtherWASHINGTON DEPARTMENT OF HEALTH