MEDICARE: JEFFREY PAUL OLSEN LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP3850	MN

General Provider Information

NPI Number	:	1073161220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY PAUL OLSEN LP

Provider Business Mailing Address
First Line	:	2275 YOUNGMAN AVE STE 204
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3053
Country	:	US
Telephone Number	:	148-761-2247
Fax Number	:

Provider Business Practice Location Address
First Line	:	2275 YOUNGMAN AVE STE 204
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3053
Country	:	US
Telephone Number	:	148-761-2247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	12/11/2019

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Directions to “ JEFFREY PAUL OLSEN LP” Practice Location

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