Provider Demographics
NPI:1114505971
Name:EDELMAN, OLIVIA ANN
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANN
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 ROSEMONT BLVD APT 102B
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9255
Mailing Address - Country:US
Mailing Address - Phone:248-494-2399
Mailing Address - Fax:
Practice Address - Street 1:150 N MILLER RD STE 150A
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3713
Practice Address - Country:US
Practice Address - Phone:330-867-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20201600-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist