Provider Demographics
NPI:1174765176
Name:OLSON, KERRI L (PHD)
Entity type:Individual
Prefix:DR
First Name:KERRI
Middle Name:L
Last Name:OLSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KERRI
Other - Middle Name:L
Other - Last Name:BRADLEY-RONNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:325 N WELLS ST
Mailing Address - Street 2:MM1346
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7024
Mailing Address - Country:US
Mailing Address - Phone:312-329-6647
Mailing Address - Fax:312-467-0130
Practice Address - Street 1:325 N WELLS ST
Practice Address - Street 2:MM1346
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-7024
Practice Address - Country:US
Practice Address - Phone:312-329-6647
Practice Address - Fax:312-467-0130
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004803103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist