Provider Demographics
NPI:1245609668
Name:OLSON, BRIDGET
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 SHURTLEFF AVE
Mailing Address - Street 2:#2
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-4209
Mailing Address - Country:US
Mailing Address - Phone:707-492-4407
Mailing Address - Fax:
Practice Address - Street 1:2187 SHURTLEFF AVE
Practice Address - Street 2:#2
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-4209
Practice Address - Country:US
Practice Address - Phone:707-492-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist