Healthcare Provider Details

I. General information

NPI: 1275457624
Provider Name (Legal Business Name): KRYSTAL OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 BELLE AVE
MANKATO MN
56001-5250
US

IV. Provider business mailing address

1111 WARREN ST
MANKATO MN
56001-4661
US

V. Phone/Fax

Practice location:
  • Phone: 877-909-5511
  • Fax:
Mailing address:
  • Phone: 877-909-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: