Provider Demographics
NPI:1932474350
Name:OLESEN, NANCY ANN (MA, LP, MHPRAC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:OLESEN
Suffix:
Gender:F
Credentials:MA, LP, MHPRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 CAPITOL HTS
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1852
Mailing Address - Country:US
Mailing Address - Phone:651-221-9880
Mailing Address - Fax:651-225-1545
Practice Address - Street 1:796 CAPITOL HTS
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1852
Practice Address - Country:US
Practice Address - Phone:651-221-9880
Practice Address - Fax:651-225-1545
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MNLP5359103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling