Provider Demographics
NPI:1548922305
Name:OLSON, AMBER ROXANA
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ROXANA
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:ROXANA
Other - Last Name:CARBAJAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3825 N RAMSEY RD APT 2504
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-1624
Mailing Address - Country:US
Mailing Address - Phone:559-765-5319
Mailing Address - Fax:
Practice Address - Street 1:3825 N RAMSEY RD APT 2504
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-1624
Practice Address - Country:US
Practice Address - Phone:559-765-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician