Provider Demographics
NPI:1710635438
Name:OLSEN, ANDREW RAYMOND (SUDP)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RAYMOND
Last Name:OLSEN
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:405 W STEWART STE A
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5164
Mailing Address - Country:US
Mailing Address - Phone:800-231-4303
Mailing Address - Fax:253-272-0171
Practice Address - Street 1:405 W STEWART STE A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5164
Practice Address - Country:US
Practice Address - Phone:800-231-4303
Practice Address - Fax:253-272-0171
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WACP61200273101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP61200273OtherWASHINGTON DEPARTMENT OF HEALTH