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Individual

DR. PHYLLIS M. OLSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3310 S MAIN STREET, SUITE D1, ANDERSON, IN 46013-4234
(765) 622-7622
Mailing address
PO BOX 605, ALEXANDRIA, IN 46001-0605
(765) 233-1102
(765) 233-1103

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041304A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200203950
IN
Enumeration date
07/12/2006
Last updated
09/05/2007
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