Provider Demographics
NPI:1780150003
Name:OLIVERSEN, VICTORIA BERYL (BCBA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:BERYL
Last Name:OLIVERSEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:BERYL
Other - Last Name:ZELINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5268
Mailing Address - Country:US
Mailing Address - Phone:920-410-1667
Mailing Address - Fax:
Practice Address - Street 1:4330 GOLF TER
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4683
Practice Address - Country:US
Practice Address - Phone:920-410-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty