Provider Demographics
NPI:1831522606
Name:OLSON, LEAH (CA)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E LONGVIEW DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2155
Mailing Address - Country:US
Mailing Address - Phone:920-574-0447
Mailing Address - Fax:
Practice Address - Street 1:612 E LONGVIEW DR
Practice Address - Street 2:SUITE B
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2155
Practice Address - Country:US
Practice Address - Phone:920-574-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI563-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist