Provider Demographics
NPI:1316798242
Name:OLSON, CHARLOTTE ELIZABETH MCEVOY
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ELIZABETH MCEVOY
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 OLD CEDAR AVE S APT 316
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-2409
Mailing Address - Country:US
Mailing Address - Phone:651-217-3637
Mailing Address - Fax:
Practice Address - Street 1:321 WILSON ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2804
Practice Address - Country:US
Practice Address - Phone:651-217-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst