Provider Demographics
NPI:1750820148
Name:OLSON, KATIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:BARKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:303 CATLIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1947
Mailing Address - Country:US
Mailing Address - Phone:763-684-7942
Mailing Address - Fax:
Practice Address - Street 1:303 CATLIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1947
Practice Address - Country:US
Practice Address - Phone:763-684-7942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3565133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered