Provider Demographics
NPI:1174039697
Name:OLSON, MELISSA YVETTE (TEACHER'S LICENCE)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:YVETTE
Last Name:OLSON
Suffix:
Gender:F
Credentials:TEACHER'S LICENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 SEQUOIA RD NW APT A25
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3415
Mailing Address - Country:US
Mailing Address - Phone:505-550-1016
Mailing Address - Fax:
Practice Address - Street 1:6101 SEQUOIA RD NW
Practice Address - Street 2:APT A25
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-8712
Practice Address - Country:US
Practice Address - Phone:505-550-1016
Practice Address - Fax:505-550-1016
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician