Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY17023 | CA |
NPI | 1104986587 |
---|---|
Provider Name | Michelle Therese Olson |
First Address | Fresno, CA 93726-0513 |
Second Address | Fresno, CA 93726-0513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 30/12/2021 |