Provider Demographics
NPI:1528244589
Name:OLSON, TONJA MARIE (HIS)
Entity type:Individual
Prefix:MRS
First Name:TONJA
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8710
Mailing Address - Country:US
Mailing Address - Phone:715-736-0151
Mailing Address - Fax:715-234-8590
Practice Address - Street 1:3013 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8710
Practice Address - Country:US
Practice Address - Phone:715-736-0151
Practice Address - Fax:715-234-8590
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1146174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist