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NPI Code Detail

MEDICARE: MIRANDA RENEE OLSON

MEDICARE: MIRANDA RENEE OLSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1366284879
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA RENEE OLSON
Provider Business Mailing Address
First Line : 6732 EMERSON AVE N
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55430-1524
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5215 EDINA INDUSTRIAL BLVD
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55439-2926
Country : US
Telephone Number : 310-856-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2024
Last Update Date : 06/07/2024

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Directions to “ MIRANDA RENEE OLSON ” Practice Location

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