Provider Demographics
NPI:1588756779
Name:OLMSTED, STEPHEN W (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:OLMSTED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N 2ND AVE E
Mailing Address - Street 2:STE 304
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802
Mailing Address - Country:US
Mailing Address - Phone:218-722-1254
Mailing Address - Fax:218-525-4703
Practice Address - Street 1:8 N 2ND AVE E
Practice Address - Street 2:STE 304
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802
Practice Address - Country:US
Practice Address - Phone:218-722-1254
Practice Address - Fax:218-525-4703
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPO602103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN746050LOtherBCBS