Provider Demographics
NPI:1396220331
Name:OLSON, EVANGELINA DORI (BSW)
Entity Type:Individual
Prefix:MRS
First Name:EVANGELINA
Middle Name:DORI
Last Name:OLSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MS
Other - First Name:EVANGELINA
Other - Middle Name:DORI
Other - Last Name:SOLANO ROSAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BT
Mailing Address - Street 1:1803 W MARCH LN STE C&D
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6414
Mailing Address - Country:US
Mailing Address - Phone:209-636-5353
Mailing Address - Fax:209-636-5354
Practice Address - Street 1:1803 W MARCH LN STE C&D
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6414
Practice Address - Country:US
Practice Address - Phone:209-636-5353
Practice Address - Fax:209-636-5354
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician