Healthcare Provider Details

I. General information

NPI: 1700114584
Provider Name (Legal Business Name): KAKLAUSKAS OLSON GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 11TH ST. STE. 211
BOULDER CO
80302
US

IV. Provider business mailing address

1911 11TH ST. STE. 211
BOULDER CO
80302
US

V. Phone/Fax

Practice location:
  • Phone: 303-545-9392
  • Fax: 303-545-9394
Mailing address:
  • Phone: 303-545-9392
  • Fax: 303-545-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC2223
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6504
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992389
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ELIZABETH ANN OLSON
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: PSYD., LCSW
Phone: 303-545-9392