Provider Demographics
NPI:1134517105
Name:OLSEN, MARY (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:LYTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:6515 GLENHILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-5237
Mailing Address - Country:US
Mailing Address - Phone:972-754-7086
Mailing Address - Fax:
Practice Address - Street 1:6515 GLENHILL DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-5237
Practice Address - Country:US
Practice Address - Phone:972-754-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist