Provider Demographics
NPI:1841399383
Name:OLSON, JUDITH K (PHD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:K
Last Name:OLSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5106
Mailing Address - Country:US
Mailing Address - Phone:307-745-8475
Mailing Address - Fax:307-745-5138
Practice Address - Street 1:526 REGENCY DR
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5106
Practice Address - Country:US
Practice Address - Phone:307-745-8475
Practice Address - Fax:307-745-5138
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY75103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY830277301 82070 A001OtherTRICARE
WY830277301-001OtherMBA
WY138809OtherMHN
WYOLS305030OtherBLUECROSS/BLUESHIELD
WY830277301 82070 A001OtherTRICARE
WYOLS305030OtherBLUECROSS/BLUESHIELD