Healthcare Provider Details

I. General information

NPI: 1972207843
Provider Name (Legal Business Name): JILLIAN OLNEY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 04/04/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 N UNION BLVD STE 202
COLORADO SPRINGS CO
80918-2069
US

IV. Provider business mailing address

6835 HOLT DR
COLORADO SPRINGS CO
80922-1607
US

V. Phone/Fax

Practice location:
  • Phone: 707-305-9425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0006022
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: