Individual
KELLY OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 25TH ST S, FARGO, ND 58103-2311
(701) 451-4900
(651) 925-0057
Mailing address
1201 25TH ST S, FARGO, ND 58103-2311
(701) 451-4900
(651) 925-0057
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
1074
MN
106H00000X
Marriage & Family Therapist
Primary
2009-023
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2352433
AMERICA'S PPO
MN
01
—
245K1OL
BCBS MN
MN
01
—
3100200502
PRIMEWEST HEALTH
MN
01
—
56560-B005
TRIWEST
MN
05
—
727623100
—
MN
01
—
9398252
PHCS
MN
01
—
HP51290
HEALTH PARTNERS
MN
Enumeration date
03/27/2007
Last updated
02/25/2020
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