Lake Superior Psychological Services, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LP4532 Issued in MN

Legal business name

LAKE SUPERIOR PSYCHOLOGICAL SERVICES, INC.

Practice address

4891 Miller Trunk Hwy
Suite 106
Hermantown, MN 55811-1512

Phone

(218) 722-2525

Fax

(218) 722-1033

NPI assigned

Nov 26, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey Lynn Olson, PSY D, LP

Title

Clinical Psychologist

Phone

(218) 722-2525

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360108800000",
    "number": "1396089660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4891 MILLER TRUNK HWY",
            "address_2": "SUITE 106",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558111512",
            "telephone_number": "218-722-2525",
            "fax_number": "218-722-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4891 MILLER TRUNK HWY",
            "address_2": "SUITE 106",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558111512",
            "telephone_number": "218-722-2525",
            "fax_number": "218-722-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SUPERIOR PSYCHOLOGICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-26",
        "last_updated": "2013-02-06",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "218-722-2525",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY D, LP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "LP4532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Kunkel, PT
• Tracy Kwapick, FNP/PMHNP
• Ally Kyllonen, M.A., CCC-SLP
• Cari Michelle Labonne
• Duane J Lahti Jr., DPT, CMTPT
• Hannah Marie Lamkin
• Noah Ronald Lane
• Paul Andrew Larkin
• Alexis Summerville Ledoux
• Jayci Kay Lee

• Community/Behavioral Health Agency in Hermantown, MN
• Providers in Hermantown, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.