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General NPI Number Information
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NPI Number | 1851459614
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Entity Type | Individual
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Provider Name | KENNETH A OLSON M.A., M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9033 BASELINE RD, SUITE H
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730
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Country | US
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Telephone | 909-989-9030
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Fax | 909-466-4594
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Provider Business Mailing Address
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Address Line | 9033 BASELINE RD H
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1255
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Country | US
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Telephone | 909-989-9030
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Fax | 909-466-4594
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC27997
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License Number State | CA
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