Healthcare Provider Details

I. General information

NPI: 1114712593
Provider Name (Legal Business Name): DENISE OLMSTEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28245 CROCKER AVENUE SUITE 220
SANTA CLARITA CA
91355
US

IV. Provider business mailing address

28245 AVENUE CROCKER SUITE 220
CANYON COUNTRY CA
91533
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-7086
  • Fax:
Mailing address:
  • Phone: 661-254-7086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: