Provider Demographics
NPI:1790708881
Name:OLSON, RALPH LLOYD JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:LLOYD
Last Name:OLSON
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W WASHINGTON ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4359
Mailing Address - Country:US
Mailing Address - Phone:906-225-5462
Mailing Address - Fax:906-225-5462
Practice Address - Street 1:220 W WASHINGTON ST
Practice Address - Street 2:SUITE 420
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4359
Practice Address - Country:US
Practice Address - Phone:906-225-5462
Practice Address - Fax:906-225-5462
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008509103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN21660002Medicare ID - Type Unspecified