Provider Demographics
NPI:1417364191
Name:OLANOFF, KELLY DAWN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:DAWN
Last Name:OLANOFF
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 VARSITY LN
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3906
Mailing Address - Country:US
Mailing Address - Phone:908-670-1084
Mailing Address - Fax:
Practice Address - Street 1:208 VARSITY LN
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3906
Practice Address - Country:US
Practice Address - Phone:908-670-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO1-0001384235Z00000X
MD08403235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist