Provider Demographics
NPI:1144203530
Name:OLSEN, RANDALL R (AUD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:R
Last Name:OLSEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5267 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-1550
Mailing Address - Country:US
Mailing Address - Phone:216-485-5767
Mailing Address - Fax:216-485-5768
Practice Address - Street 1:5267 PEARL RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-1550
Practice Address - Country:US
Practice Address - Phone:216-485-5767
Practice Address - Fax:216-485-5768
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00215231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0420066Medicaid
OH0583271OtherMEDICARE #
OH000000133435OtherAUDIOLOGY