Healthcare Provider Details

I. General information

NPI: 1669027025
Provider Name (Legal Business Name): KELLY ERIN OLSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 S WALDEN ST
SEATTLE WA
98144-6830
US

IV. Provider business mailing address

2821 S WALDEN ST
SEATTLE WA
98144-6830
US

V. Phone/Fax

Practice location:
  • Phone: 312-635-0973
  • Fax: 312-635-0050
Mailing address:
  • Phone: 312-635-0973
  • Fax: 312-635-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: