Provider Demographics
NPI:1750273033
Name:OLSEN, SHAWNA T (LE)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:T
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19259 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:BLACHLY
Mailing Address - State:OR
Mailing Address - Zip Code:97412-9740
Mailing Address - Country:US
Mailing Address - Phone:541-206-3139
Mailing Address - Fax:
Practice Address - Street 1:19259 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:BLACHLY
Practice Address - State:OR
Practice Address - Zip Code:97412-9740
Practice Address - Country:US
Practice Address - Phone:541-206-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAPE10249209174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist