Individual
MOLLY OLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
1265 E POPLAR ST, POCATELLO, ID 83201-3830
(208) 233-8309
Mailing address
PO BOX 4941, POCATELLO, ID 83205-4941
(208) 233-8309
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8069741
—
ID
Enumeration date
06/06/2008
Last updated
06/06/2008
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