Provider Demographics
NPI:1225133655
Name:OLSON, KERN ALVIN (PHD)
Entity Type:Individual
Prefix:
First Name:KERN
Middle Name:ALVIN
Last Name:OLSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 SW GEARHART DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6680
Mailing Address - Country:US
Mailing Address - Phone:503-705-8727
Mailing Address - Fax:
Practice Address - Street 1:2311 NW NORTHRUP ST
Practice Address - Street 2:207
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2994
Practice Address - Country:US
Practice Address - Phone:503-705-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical