Provider Demographics
NPI:1285706473
Name:OLSON-ANDERSON, KERRY ANN (MA, LP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:OLSON-ANDERSON
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 OAKVIEW LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3941
Mailing Address - Country:US
Mailing Address - Phone:612-508-5623
Mailing Address - Fax:
Practice Address - Street 1:2016 OAKVIEW LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3941
Practice Address - Country:US
Practice Address - Phone:612-508-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5069103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist