Individual
SHELLY OLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5448 W ISLAND LAKE RD, DULUTH, MN 55803-8405
(218) 393-0233
Mailing address
5448 W ISLAND LAKE RD, DULUTH, MN 55803-8405
(218) 393-0233
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
1076151-1-HCBS
MN
Other
Enumeration date
11/25/2014
Last updated
11/25/2014
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