Provider Demographics
NPI:1275853871
Name:OLSAVSKY, KAREN ANN (SLPA)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:ANN
Last Name:OLSAVSKY
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-3865
Mailing Address - Country:US
Mailing Address - Phone:928-554-6892
Mailing Address - Fax:
Practice Address - Street 1:1515 LAKE HAVASU AVE N STE 100
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86404-1177
Practice Address - Country:US
Practice Address - Phone:928-854-5439
Practice Address - Fax:928-854-5440
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11902355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ118748Medicare PIN