Healthcare Provider Details

I. General information

NPI: 1295265866
Provider Name (Legal Business Name): ANGELA OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/29/2026
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 30TH AVE NW STE D
MINOT ND
58703-0611
US

IV. Provider business mailing address

1015 S BROADWAY STE 18
MINOT ND
58701-4667
US

V. Phone/Fax

Practice location:
  • Phone: 701-858-1801
  • Fax:
Mailing address:
  • Phone: 701-857-8500
  • Fax: 701-857-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1898
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: