Individual
MR. JEREMIAH LEE OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC, ICS
Contact information
Practice address
1300 SOUTH DRIVE, WINNEBAGO, WI 54985-0009
(920) 235-4910
(920) 237-2043
Mailing address
1300 SOUTH DRIVE, WINNEBAGO, WI 54985-0009
(920) 235-4910
(920) 237-2043
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11698
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39171000
—
WI
Enumeration date
01/22/2007
Last updated
10/28/2010
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