Provider Demographics
NPI:1942501887
Name:OLSON, NANCY DIANE (MA, NCC, LCPC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:DIANE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MA, NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 US HIGHWAY 14
Mailing Address - Street 2:SUITE C
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-2706
Mailing Address - Country:US
Mailing Address - Phone:815-529-9260
Mailing Address - Fax:
Practice Address - Street 1:8600 US HIGHWAY 14
Practice Address - Street 2:SUITE C
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-2706
Practice Address - Country:US
Practice Address - Phone:815-529-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008494101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor