Provider Demographics
NPI:1003027210
Name:OLSEN, KATHRYN M (AUD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:OLSEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12780 W. NORTH AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:262-784-9300
Mailing Address - Fax:
Practice Address - Street 1:12780 W NORTH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4601
Practice Address - Country:US
Practice Address - Phone:262-784-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist