Provider Demographics
NPI:1003585076
Name:BUCKLEY, OLIVIA JOY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JOY
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WASHINGTON ST APT 414
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3998
Mailing Address - Country:US
Mailing Address - Phone:603-686-4181
Mailing Address - Fax:
Practice Address - Street 1:61 LOCUST ST APT 414
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3753
Practice Address - Country:US
Practice Address - Phone:603-740-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist