Healthcare Provider Details

I. General information

NPI: 1003185232
Provider Name (Legal Business Name): LINDSAY ELIZABETH OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSAY ELIZABETH HOLST

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5279 KYLER AVE NE SUITE 110
ALBERTVILLE MN
55301-4634
US

IV. Provider business mailing address

5279 KYLER AVE NE SUITE 110
ALBERTVILLE MN
55301-4634
US

V. Phone/Fax

Practice location:
  • Phone: 763-951-3091
  • Fax: 763-951-3097
Mailing address:
  • Phone: 763-951-3091
  • Fax: 763-951-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: