| Doctor Name: | ROGER OLSEN |
| NPI Number: | 1043347131 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LP, PSY.D |
| License Number: | |
| Business Practice Address: | 4660 Slater Rd Suite 210 Eagan, MN - 551224047 |
| Business Phone Number: | 6518826299 |
| Business Fax Number: | 6516830057 |
| Mailing Address: | 4660 Slater Rd, Suite 210 EAGAN |
| State: | MN |
| Postal Code: | 551224047 |
| Phone Number: | 6518826299 |
| Fax Number: | 6516830057 |
| NPI Enumeration Date: | 02/27/2007 |
| NPI Last Update Date: | 09/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |