Provider Demographics
NPI:1316160435
Name:OLSEN, JOANN (MD)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9669 KENTON AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1226
Mailing Address - Country:US
Mailing Address - Phone:847-677-0560
Mailing Address - Fax:847-679-8002
Practice Address - Street 1:9669 KENTON AVE STE 209
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1226
Practice Address - Country:US
Practice Address - Phone:847-677-0560
Practice Address - Fax:847-679-8002
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine