Provider Demographics
NPI:1265259675
Name:OLSOVSKY, ROSE (LAC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:OLSOVSKY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 N WILLIS BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6163
Mailing Address - Country:US
Mailing Address - Phone:503-442-4912
Mailing Address - Fax:
Practice Address - Street 1:609 NE BAKER ST STE 250
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4950
Practice Address - Country:US
Practice Address - Phone:541-862-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC219183171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist