Provider Demographics
NPI:1871614305
Name:OLSON, JENNIFER A (LMP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 W 3RD AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-4512
Mailing Address - Country:US
Mailing Address - Phone:509-838-1770
Mailing Address - Fax:509-838-3331
Practice Address - Street 1:933 W 3RD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-4512
Practice Address - Country:US
Practice Address - Phone:509-838-1770
Practice Address - Fax:509-838-3331
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023219225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist