Provider Demographics
NPI:1881723948
Name:OLSGAARD, JEFF N (MA, MDIV, NCC, LCPC)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:N
Last Name:OLSGAARD
Suffix:
Gender:M
Credentials:MA, MDIV, 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:PO BOX 13765
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-0765
Mailing Address - Country:US
Mailing Address - Phone:971-266-0536
Mailing Address - Fax:888-875-7309
Practice Address - Street 1:1700 NW CIVIC DR
Practice Address - Street 2:SUITE 310
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3770
Practice Address - Country:US
Practice Address - Phone:503-666-8832
Practice Address - Fax:503-669-8641
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT867 - LCPC101YP2500X
ORLPC C3060101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT740233OtherBLUECROSS BLUESHIELD
1881723948OtherNATIONAL PROVIDER IDENTIF
12168943OtherCOUNCIL FOR AFFORDABLE QUALITY HEALTHCARE (CAQH)
MT252790Medicaid