Provider Demographics
NPI:1487987269
Name:OLSON, KAREN ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:OLSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:823 6TH ST
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-2011
Mailing Address - Country:US
Mailing Address - Phone:906-221-0856
Mailing Address - Fax:
Practice Address - Street 1:216 E LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-2918
Practice Address - Country:US
Practice Address - Phone:906-239-9918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI82-4463331OtherST CHARLES PSYCHOTHERAPY SERVICES, PLLC