Provider Demographics
NPI:1750845608
Name:OLSON, CHELSEY SADIE ISABELLE (HHA)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:SADIE ISABELLE
Last Name:OLSON
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19180 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-5646
Mailing Address - Country:US
Mailing Address - Phone:760-493-0547
Mailing Address - Fax:
Practice Address - Street 1:19180 WILLOW ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-5646
Practice Address - Country:US
Practice Address - Phone:760-493-0547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHO43886251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHO43886OtherCITY