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General NPI Number Information
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NPI Number | 1477336139
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Entity Type | Individual
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Provider Name | OLIVIA CHRISTINA PRESTON PHD
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Gender | Female
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 2501 HANLEY RD STE 201
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City | HUDSON
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State | WI
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Zip | 54016-8786
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Country | US
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Telephone | 534-544-5247
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 44008
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City | JACKSONVILLE
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State | FL
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Zip | 32231-4008
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Country | US
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Telephone | 904-244-3289
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY11988
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License Number State | FL
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