Healthcare Provider Details

I. General information

NPI: 1780618165
Provider Name (Legal Business Name): SUSAN OLLAR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 MARTIN DR
BOULDER CO
80305-5447
US

IV. Provider business mailing address

3705 MARTIN DR
BOULDER CO
80305-5447
US

V. Phone/Fax

Practice location:
  • Phone: 303-499-4869
  • Fax: 303-494-7878
Mailing address:
  • Phone: 303-499-4869
  • Fax: 303-494-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1402
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1402
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1402
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1402
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1402
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number1402
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number1402
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: