Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003379686 |
---|---|
Provider Name | Kendall Marie Olson |
First Address | Burnsville, MN 55306-6945 |
Second Address | Minnetonka, MN 55343-3944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2019 |
Last Update Date | 10/04/2019 |