Provider Demographics
NPI:1902262553
Name:OLSEN, RYAN THOMAS-EDDINS
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS-EDDINS
Last Name:OLSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220291
Mailing Address - Street 2:
Mailing Address - City:CENTERFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84622-0291
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 E 100 N
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:UT
Practice Address - Zip Code:84634
Practice Address - Country:US
Practice Address - Phone:435-528-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10403312-35011041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical