MEDICARE: KAIA BRIELLE OLSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1457072035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAIA BRIELLE OLSON

Provider Business Mailing Address
First Line	:	69823 NORTHHAMPTON AVE
Second Line	:
City	:	CATHEDRAL CTY
State	:	CA
Zip	:	92234-2591
Country	:	US
Telephone Number	:	760-449-0904
Fax Number	:

Provider Business Practice Location Address
First Line	:	69823 NORTHHAMPTON AVE
Second Line	:
City	:	CATHEDRAL CTY
State	:	CA
Zip	:	92234-2591
Country	:	US
Telephone Number	:	760-449-0904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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Directions to “ KAIA BRIELLE OLSON ” Practice Location

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