Alicia Marie Olson
Individual provider Active NPI Intellectual and/or Developmental Disabilities Residential Treatment Facility · Zimmerman, MN
NPI 1639710593 · NPPES record last updated Oct 2, 2019
Key facts
- NPI
- 1639710593
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
- License
- 1101018 (MN)
- Practice address
- 25844 10TH St W
Zimmerman, MN 55398-8796 - Phone
- (763) 202-9054
- NPI assigned
- Oct 2, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1101018 | MN | MD | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | 1101018 | MN | Yes |
Addresses
Primary practice location
25844 10TH St W
Zimmerman, MN 55398-8796
Mailing address
25844 10TH St W
Zimmerman, MN 55398-8796
Other providers in Zimmerman, MN
- Gregory Rueben Nelson
- Jan Marie Nicodemus
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- Northern Engineering & Manufacturing Inc
- Northwoods Home Care LLC
- Matt Onstad
- Open Harbors Inc.
- P&P Investors, Inc.
- Dhrutiben Khodabhai Patel
- Kara Josephine Person
All providers in Zimmerman, MN · Intellectual and/or Developmental Disabilities Residential Treatment Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.