Provider Demographics
NPI:1326332925
Name:DAVOLI, LISA OLSON (MS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:OLSON
Last Name:DAVOLI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-0491
Mailing Address - Country:US
Mailing Address - Phone:716-812-0053
Mailing Address - Fax:
Practice Address - Street 1:355 HARLEM RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1825
Practice Address - Country:US
Practice Address - Phone:716-821-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant