Provider Demographics
NPI:1164576310
Name:OLSON, ERIN S (SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:S
Last Name:OLSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3824
Mailing Address - Country:US
Mailing Address - Phone:815-545-3577
Mailing Address - Fax:815-462-2620
Practice Address - Street 1:752 COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3824
Practice Address - Country:US
Practice Address - Phone:815-545-3577
Practice Address - Fax:815-462-2620
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932457OtherBCBS ID #