Healthcare Provider Details

I. General information

NPI: 1609731694
Provider Name (Legal Business Name): KAITLYN OLSCHLAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 3RD ST NW
EAST GRAND FORKS MN
56721-1713
US

IV. Provider business mailing address

1547 30TH AVE S
MOORHEAD MN
56560-5149
US

V. Phone/Fax

Practice location:
  • Phone: 218-287-4338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: