Basic Information
| Provider Information | |||||||||
| NPI: | 1376802801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLSEN | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1655 PALM BEACH LAKES BLVD STE 600 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334012208 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1655 PALM BEACH LAKES BLVD STE 600 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334012208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618812822 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2012 | ||||||||
| LastUpdateDate: | 04/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 222Q00000X | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 104100000X | FL | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.