MEDICARE: NANCY JEAN OLSEN M.S.

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	101YP2500X	Professional Counselor	4339-125	WI
2	101YP2500X	Professional Counselor	1599	MN

General Provider Information

NPI Number	:	1073835047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY JEAN OLSEN M.S.

Provider Business Mailing Address
First Line	:	821 RAYMOND AVE STE 240
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1525
Country	:	US
Telephone Number	:	612-749-2405
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 RAYMOND AVE STE 240
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1525
Country	:	US
Telephone Number	:	612-749-2405
Fax Number	:

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

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	06/17/2016

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