MEDICARE: GRACE EVELYN 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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1396617130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE EVELYN OLSON

Provider Business Mailing Address
First Line	:	4402 HAINES RD STE 1
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-2852
Country	:	US
Telephone Number	:	218-279-8364
Fax Number	:

Provider Business Practice Location Address
First Line	:	4402 HAINES RD STE 1
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-2852
Country	:	US
Telephone Number	:	218-279-8364
Fax Number	:

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

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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Directions to “ GRACE EVELYN OLSON ” Practice Location

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