Provider Demographics
NPI:1326665217
Name:ALTHEA R OLSON PC
Entity type:Organization
Organization Name:ALTHEA R OLSON PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-244-1751
Mailing Address - Street 1:15724 S ROUTE 59 STE 102
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2806
Mailing Address - Country:US
Mailing Address - Phone:630-527-8877
Mailing Address - Fax:630-527-8877
Practice Address - Street 1:15724 S ROUTE 59 STE 102
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2806
Practice Address - Country:US
Practice Address - Phone:630-527-8877
Practice Address - Fax:630-527-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL34096462201Medicaid
IL149008446Medicaid
IL32070392801Medicaid
IL341463135001Medicaid