MR. JEREMIAH LEE OLSON CSAC ICS NPI 1952455800

NPI Information

  • NPI: 1952455800
  • Provider Name: MR. JEREMIAH LEE OLSON, CSAC, ICS
  • Classification: Counselor - 101YA0400X
  • Specialization: Addiction (Substance Use Disorder)
  • Entity Type: Individual
  • Address: 1300 SOUTH DRIVE
    WINNEBAGO, WI
    ZIP 54985
  • Phone: (920) 235-4910

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NPI Details

MR. Jeremiah Lee Olson, CSAC, ICS is an addiction (substance use disorder) counselor in Winnebago, WI. MR. Jeremiah Lee Olson, CSAC, ICS NPI is 1952455800. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1300 SOUTH DRIVE
WINNEBAGO, WI
ZIP 54985-009
Phone: (920) 235-4910
Fax: (920) 237-2043

The enumeration date for this NPI number is 1/22/2007 and was last updated on 10/28/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)11698WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
139171000MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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