Provider Demographics
NPI:1386171304
Name:OLSON, DANIELLE ANN
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANN
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 1:4161 18TH AVE S APT 317
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7423
Mailing Address - Country:US
Mailing Address - Phone:218-205-4580
Mailing Address - Fax:
Practice Address - Street 1:3060 FRONTIER WAY S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8909
Practice Address - Country:US
Practice Address - Phone:701-232-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1567235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist