Jeffrey L Olson, PSYD LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP4532 Issued in MN

Practice address

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

Phone

(218) 722-2525

Fax

(218) 722-1033

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353888000000",
    "number": "1881795276",
    "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": {
        "last_name": "OLSON",
        "first_name": "JEFFREY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PSYD LP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2012-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "572408200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Nothongkham, DDS
• Matthew O'Connor
• Mara Beth Olinger, PA-C
• Anthony W Olson
• Brenda Lynn Olson
• Haley Oswald
• Avery Overlie
• Hanna Dawn Pantlin
• Joseph Scott Parpala, D.C.
• PDG, P.a. (Park Dental Hermantown)

• Clinical Psychologist in Hermantown, MN
• Providers in Hermantown, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2012; 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.