Shelly Olson

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

1076151-1-HCBS Issued in MN

Practice address

5448 W Island Lake Rd
Duluth, MN 55803-8405

Phone

(218) 393-0233

NPI assigned

Nov 25, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1416873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416873600000",
    "number": "1801293444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5448 W ISLAND LAKE RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558038405",
            "telephone_number": "218-393-0233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5448 W ISLAND LAKE RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558038405",
            "telephone_number": "218-393-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "SHELLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-25",
        "last_updated": "2014-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MN",
            "license": "1076151-1-HCBS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paige Sierra Olson, APRN, CNM
• Patricia Ann Olson, RN
• Patricia Ann Olson, LICSW
• Richard Olson
• Ruth Elaine Olson
• Tawny Loera Olson, PHARMD
• Wendy Michelle Olson, LICSW
• Itunu Olukoga
• Omnia Wellness and Recovery
• Emily C. Onello, MD

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Duluth, MN
• Providers in Duluth, MN by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; 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.