Provider Demographics
NPI:1518786375
Name:OLSON, NICOLE CHERI (LEP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CHERI
Last Name:OLSON
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27000 W LUGONIA AVE APT 9101
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2092
Mailing Address - Country:US
Mailing Address - Phone:760-265-2633
Mailing Address - Fax:
Practice Address - Street 1:7707 CALLE CASINO
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1815
Practice Address - Country:US
Practice Address - Phone:909-736-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP4463103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool