Provider Demographics
NPI:1740609957
Name:OLSON, ANNIE
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 E RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MN
Mailing Address - Zip Code:56762-1384
Mailing Address - Country:US
Mailing Address - Phone:218-289-0628
Mailing Address - Fax:
Practice Address - Street 1:603 BRUCE ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-2914
Practice Address - Country:US
Practice Address - Phone:218-289-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN198021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical