Provider Demographics
NPI:1922469709
Name:OLSON, LAURI (SAC-IT)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N NORTHFORK DR
Mailing Address - Street 2:WAUSAU
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-8970
Mailing Address - Country:US
Mailing Address - Phone:715-298-9209
Mailing Address - Fax:
Practice Address - Street 1:209 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5475
Practice Address - Country:US
Practice Address - Phone:715-845-3637
Practice Address - Fax:715-845-1977
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16846-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)