Provider Demographics
NPI:1225610249
Name:OLSON, KAYLIE (RBT)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 LAKESIDE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2136
Mailing Address - Country:US
Mailing Address - Phone:559-349-3680
Mailing Address - Fax:
Practice Address - Street 1:3016 POLAR LN BLDG 3
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3031
Practice Address - Country:US
Practice Address - Phone:512-593-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-162847106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician