Provider Demographics
NPI:1891489761
Name:OLSEN, TANNER
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:OLSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 GOLDEN TRIANGLE DR STE A
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3733
Mailing Address - Country:US
Mailing Address - Phone:952-767-5900
Mailing Address - Fax:
Practice Address - Street 1:7615 GOLDEN TRIANGLE DR STE A
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3733
Practice Address - Country:US
Practice Address - Phone:952-767-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician