Provider Demographics
NPI:1346651106
Name:PSENCIK, OLIVIA PAIGE (MS, SLP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:PAIGE
Last Name:PSENCIK
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 HOLLIS ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630
Mailing Address - Country:US
Mailing Address - Phone:409-988-3429
Mailing Address - Fax:
Practice Address - Street 1:870 CENTER ST
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-2527
Practice Address - Country:US
Practice Address - Phone:409-988-3429
Practice Address - Fax:409-600-8521
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107816235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist