Provider Demographics
NPI:1528545878
Name:OLSEN, BRIDGETTE (M ED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:M ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 E SPRAGUE AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-3109
Mailing Address - Country:US
Mailing Address - Phone:509-505-9614
Mailing Address - Fax:509-960-5916
Practice Address - Street 1:1722 E SPRAGUE AVE STE 214
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3109
Practice Address - Country:US
Practice Address - Phone:509-505-9614
Practice Address - Fax:509-960-5916
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WABA61243965103K00000X
WAAB61107164106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst