Healthcare Provider Details

I. General information

NPI: 1316160435
Provider Name (Legal Business Name): JOANN OLSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9669 KENTON AVE STE 209
SKOKIE IL
60076-1226
US

IV. Provider business mailing address

9669 KENTON AVE STE 209
SKOKIE IL
60076-1226
US

V. Phone/Fax

Practice location:
  • Phone: 847-677-0560
  • Fax: 847-679-8002
Mailing address:
  • Phone: 847-677-0560
  • Fax: 847-679-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: