Provider Demographics
NPI:1902173545
Name:OLSON, STEPHANIE RAE (BS, CADC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:OLSON
Suffix:
Gender:F
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 BURNETT AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6128
Mailing Address - Country:US
Mailing Address - Phone:515-233-5048
Mailing Address - Fax:
Practice Address - Street 1:712 BURNETT AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6128
Practice Address - Country:US
Practice Address - Phone:515-233-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)