Provider Demographics
NPI:1366943599
Name:JOGOLEFF-OLSTAD, CAROLYN (BCBA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:JOGOLEFF-OLSTAD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 CAMINO MAGNIFICO
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-7357
Mailing Address - Country:US
Mailing Address - Phone:619-238-4989
Mailing Address - Fax:
Practice Address - Street 1:723 CAMINO MAGNIFICO
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-7357
Practice Address - Country:US
Practice Address - Phone:619-238-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst