Individual provider Active NPI

Dena Z Olwan, PHD

  • Psychologist
  • Sioux City, IA
National Provider Identifier
1588648596
Registry record updated Aug 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
00703 Issued in IA
Practice address
401 Douglas Street
Suite 504
Sioux City, IA 51104-1471
Phone
(712) 258-1000
Fax
(712) 252-1100
NPI assigned
Dec 2, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 00703 IA
Psychologist 103T00000X 00703 IA Primary

Addresses

Primary practice location

401 Douglas Street
Suite 504
Sioux City, IA 51104-1471

Mailing address

401 Douglas St Ste 504
Sioux City, IA 51101-1471
Phone (712) 258-1000

Other identifiers 1

IdentifierTypeStateIssuer
2157180MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041220000763 IA Practitioner - Clinical Psychologist 9931167129 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1992
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

401 Douglas St
Suite 504
Sioux City, IA 51101-1471

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
00703IAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
C3, Inc PastSince Jul 25, 2021 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627776000000",
    "number": "1588648596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 DOUGLAS ST STE 504",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011471",
            "telephone_number": "712-258-1000",
            "fax_number": "712-252-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 DOUGLAS STREET",
            "address_2": "SUITE 504",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511041471",
            "telephone_number": "712-258-1000",
            "fax_number": "712-252-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLWAN",
        "first_name": "DENA",
        "middle_name": "Z",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-02",
        "last_updated": "2021-08-01",
        "certification_date": "2021-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IA",
            "license": "00703",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IA",
            "license": "00703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2157180",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

Verify at the official NPI Registry.