Healthcare Provider Details

I. General information

NPI: 1942962097
Provider Name (Legal Business Name): SHAUNDRA OLSON MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 MEGHAN LN
EAGAN MN
55122-3021
US

IV. Provider business mailing address

4230 MEGHAN LN
EAGAN MN
55122-3021
US

V. Phone/Fax

Practice location:
  • Phone: 612-466-0510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3022
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: