Healthcare Provider Details

I. General information

NPI: 1326665217
Provider Name (Legal Business Name): ALTHEA R OLSON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15724 S ROUTE 59 STE 102
PLAINFIELD IL
60544-2806
US

IV. Provider business mailing address

15724 S ROUTE 59 STE 102
PLAINFIELD IL
60544-2806
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-8877
  • Fax: 630-527-8877
Mailing address:
  • Phone: 630-527-8877
  • Fax: 630-527-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier34096462201
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 2
Identifier149008446
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 3
Identifier32070392801
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 4
Identifier341463135001
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name: ALTHEA R OLSON
Title or Position: PRACTICE OWNER
Credential: LCSW
Phone: 630-244-1751