Provider Demographics
NPI:1912463357
Name:OLSON, AMBER LYNN (EDS, NCSP)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LYNN
Last Name:OLSON
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18807 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1630
Mailing Address - Country:US
Mailing Address - Phone:402-957-3941
Mailing Address - Fax:
Practice Address - Street 1:11717 S 216TH ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-4729
Practice Address - Country:US
Practice Address - Phone:402-332-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2016009754103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool