Provider Demographics
NPI:1235320201
Name:OLIVER, LINDA SUE (MA,CCC,SLP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MA,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 ETZEL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2813
Mailing Address - Country:US
Mailing Address - Phone:314-454-0876
Mailing Address - Fax:314-869-3538
Practice Address - Street 1:7733 FORSYTH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1817
Practice Address - Country:US
Practice Address - Phone:314-869-3538
Practice Address - Fax:314-869-3538
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist