Individual
AEMON JAMES KOLASIENSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2178 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4535
(805) 781-4711
Mailing address
2178 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4535
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41518
CA
Other
Enumeration date
01/13/2022
Last updated
01/13/2022
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