| NPI | 1417490681 |
|---|---|
| Former Name | KELLIE OLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.012970) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.012283) |
| 101YP2500X Counselor, Professional (Licence: IL 178012283) | |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2020-06-23 |