Provider Demographics
NPI:1740574409
Name:OLSEN, KIRSTA (CSW)
Entity type:Individual
Prefix:
First Name:KIRSTA
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 RIDGEVIEW DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2665
Mailing Address - Country:US
Mailing Address - Phone:435-668-6892
Mailing Address - Fax:
Practice Address - Street 1:750 RIDGEVIEW DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2665
Practice Address - Country:US
Practice Address - Phone:435-668-6892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7707532-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical