MEDICARE: MR. RONALD B OLSON MAC

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	101YM0800X	Mental Health Counselor	21067	SD

General Provider Information

NPI Number	:	1619858941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD B OLSON MAC

Provider Business Mailing Address
First Line	:	3409 W 47TH ST STE 102
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-6339
Country	:	US
Telephone Number	:	605-593-4075
Fax Number	:	605-401-4086

Provider Business Practice Location Address
First Line	:	3409 W 47TH ST STE 102
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-6339
Country	:	US
Telephone Number	:	605-593-4075
Fax Number	:	605-401-4086

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

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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