Active NPI
Jeffrey Paul Olsen, LP
- Psychologist
- Saint Paul, MN
National Provider Identifier
1073161220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP3850
- Practice address
- 2275 Youngman Ave Ste 204
Saint Paul, MN 55116-3053 - Phone
- (148) 761-2247
- NPI assigned
- Aug 30, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP3850 | MN | Primary |
Addresses
Primary practice location
2275 Youngman Ave Ste 204
Saint Paul, MN 55116-3053
Mailing address
2275 Youngman Ave Ste 204
Saint Paul, MN 55116-3053
Phone (148) 761-2247
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP3850 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576022400000",
"number": "1073161220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2275 YOUNGMAN AVE STE 204",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551163053",
"telephone_number": "148-761-2247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2275 YOUNGMAN AVE STE 204",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551163053",
"telephone_number": "148-761-2247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSEN",
"first_name": "JEFFREY",
"middle_name": "PAUL",
"credential": "LP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-08-30",
"last_updated": "2019-12-11",
"certification_date": "2019-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP3850",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.