Provider Demographics
NPI:1457072035
Name:OLSON, KAIA BRIELLE
Entity Type:Individual
Prefix:
First Name:KAIA
Middle Name:BRIELLE
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 1:69823 NORTHHAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CTY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-2591
Mailing Address - Country:US
Mailing Address - Phone:760-449-0904
Mailing Address - Fax:
Practice Address - Street 1:69823 NORTHHAMPTON AVE
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CTY
Practice Address - State:CA
Practice Address - Zip Code:92234-2591
Practice Address - Country:US
Practice Address - Phone:760-449-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent