Healthcare Provider Details

I. General information

NPI: 1568297281
Provider Name (Legal Business Name): TIFFANY K. OLSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30926 OLSON LN
LONE ROCK WI
53556-9009
US

IV. Provider business mailing address

30926 OLSON LN
LONE ROCK WI
53556-9009
US

V. Phone/Fax

Practice location:
  • Phone: 608-604-9199
  • Fax:
Mailing address:
  • Phone: 608-604-9199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY K OLSON
Title or Position: OWNER/THERAPIST
Credential:
Phone: 608-604-9199