NPIMap

Individual provider Active NPI

Delores Henderson-Olson, BS

  • Addiction (Substance Use Disorder) Counselor
  • Shell Lake, WI
National Provider Identifier
1730286121
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Practice address
11 Fifth Ave
Shell Lake, WI 54871-0265
Phone
(715) 468-2841
Fax
(715) 468-2374
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X Primary

Addresses

Primary practice location

11 Fifth Ave
Shell Lake, WI 54871-0265

Mailing address

11 Fifth Ave
PO Box 265
Shell Lake, WI 54871-0265
Phone (715) 468-2841

Other identifiers 1

IdentifierTypeStateIssuer
3937990MedicaidWI

Other names 1

  • Lori Olson Other name

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
Credentials
Bachelor of Science

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1730286121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 FIFTH AVE",
            "address_2": "PO BOX 265",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "548710265",
            "telephone_number": "715-468-2841",
            "fax_number": "715-468-2374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 FIFTH AVE",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "548710265",
            "telephone_number": "715-468-2841",
            "fax_number": "715-468-2374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON-OLSON",
        "first_name": "DELORES",
        "credential": "BS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3937990",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LORI",
            "last_name": "OLSON",
            "credential": "CADCIII",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shell Lake, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.