MEDICARE: LYNDA JEAN OLSON CSAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	11176-132	WI

General Provider Information

NPI Number	:	1083996854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA JEAN OLSON CSAC

Provider Business Mailing Address
First Line	:	800 WISCONSIN ST
Second Line	:	UNIT 49
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-3588
Country	:	US
Telephone Number	:	715-855-6181
Fax Number	:	715-838-2949

Provider Business Practice Location Address
First Line	:	800 WISCONSIN ST
Second Line	:	UNIT 49
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-3588
Country	:	US
Telephone Number	:	715-855-6181
Fax Number	:	715-838-2949

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

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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