Provider Demographics
NPI:1043324460
Name:OLSON, LISA MARIE (MHS, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MHS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9026 ADARE AVE
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9018
Mailing Address - Country:US
Mailing Address - Phone:708-478-6588
Mailing Address - Fax:708-478-8064
Practice Address - Street 1:9026 ADARE AVE
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9018
Practice Address - Country:US
Practice Address - Phone:708-478-6588
Practice Address - Fax:708-478-8064
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007356235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist