Provider Demographics
NPI:1235878174
Name:OLESEN-POPE, TAMI ELIZABETH
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:ELIZABETH
Last Name:OLESEN-POPE
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 1:504 E SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:GENESEE
Mailing Address - State:ID
Mailing Address - Zip Code:83832-8711
Mailing Address - Country:US
Mailing Address - Phone:208-413-4402
Mailing Address - Fax:
Practice Address - Street 1:1350 TROY RD STE 2
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3995
Practice Address - Country:US
Practice Address - Phone:208-882-6904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist