Provider Demographics
NPI:1336292671
Name:OLSEN, CLIFFORD CHARLES (PHD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:CHARLES
Last Name:OLSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5831 COTTLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3734
Mailing Address - Country:US
Mailing Address - Phone:408-363-4801
Mailing Address - Fax:
Practice Address - Street 1:5831 COTTLE RD
Practice Address - Street 2:KAISER HEARING AID CENTER
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3734
Practice Address - Country:US
Practice Address - Phone:408-363-4801
Practice Address - Fax:408-363-4813
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 1056231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist