Healthcare Provider Details

I. General information

NPI: 1366080608
Provider Name (Legal Business Name): DANIELLE OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 RAVINE VIEW DR
ROSEVILLE CA
95661-4645
US

IV. Provider business mailing address

1121 RAVINE VIEW DR
ROSEVILLE CA
95661-4645
US

V. Phone/Fax

Practice location:
  • Phone: 916-520-3687
  • Fax:
Mailing address:
  • Phone: 916-520-3687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number155438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: