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General NPI Number Information
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NPI Number | 1942237672
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Entity Type | Individual
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Provider Name | JOHN JOSEPH OLESNAVAGE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 3926 SQUAW BEACH ROAD
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City | BIG BAY
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State | MI
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Zip | 49808-0254
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Country | US
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Telephone | 906-250-4799
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Fax |
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Provider Business Mailing Address
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Address Line | 3926 SQUAW BEACH ROAD P O BOX 254
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City | BIG BAY
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State | MI
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Zip | 49808-0254
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Country | US
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Telephone | 906-250-4799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301010173
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License Number State | MI
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